Provider Demographics
NPI:1033810684
Name:BERRY, LADASHA MONIQUE (JD STUDENT)
Entity type:Individual
Prefix:MS
First Name:LADASHA
Middle Name:MONIQUE
Last Name:BERRY
Suffix:
Gender:F
Credentials:JD STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3506
Mailing Address - Country:US
Mailing Address - Phone:415-861-0828
Mailing Address - Fax:
Practice Address - Street 1:673 SAN JOSE AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4914
Practice Address - Country:US
Practice Address - Phone:510-712-7368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No172V00000XOther Service ProvidersCommunity Health Worker