Provider Demographics
NPI:1245782275
Name:MONCADA-REYES, LUIS A SR
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:MONCADA-REYES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SNEATH LN STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2349
Mailing Address - Country:US
Mailing Address - Phone:650-244-1441
Mailing Address - Fax:650-244-1447
Practice Address - Street 1:1001 SNEATH LN STE 210
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066
Practice Address - Country:US
Practice Address - Phone:650-244-1441
Practice Address - Fax:650-244-1447
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker