Provider Demographics
NPI:1942195821
Name:BURGESS, MONIFA D (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:MONIFA
Middle Name:D
Last Name:BURGESS
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 BROWNING CT
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-6045
Mailing Address - Country:US
Mailing Address - Phone:323-839-0928
Mailing Address - Fax:
Practice Address - Street 1:4740 GREEN RIVER RD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-9185
Practice Address - Country:US
Practice Address - Phone:888-515-1793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician