Active NPI
Revonda Bonita Williams
- Day Training/Habilitation Specialist
- Concord, CA
National Provider Identifier
1689411704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Day Training/Habilitation Specialist
- Practice address
- 2425 Bisso Lane Ste 100
2425 Bisso Lane Ste 100
Concord, CA 94520-4822 - Phone
- (925) 521-5620
- Fax
- (925) 521-5639
- NPI assigned
- Jul 15, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Day Training/Habilitation Specialist | 373H00000X | CA | Primary | |
| Peer Specialist | 175T00000X | MPSS-ILRHOZ | CA |
Addresses
Primary practice location
2425 Bisso Lane Ste 100
2425 Bisso Lane Ste 100
Concord, CA 94520-4822
Mailing address
105 Villa Dr
San Pablo, CA 94806-3768
Phone (510) 932-4764
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MPSS-ILRHOZ | CA | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1760054400000",
"number": "1689411704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 VILLA DR",
"city": "SAN PABLO",
"state": "CA",
"postal_code": "948063768",
"telephone_number": "510-932-4764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2425 BISSO LANE STE 100",
"address_2": "2425 BISSO LANE STE 100",
"city": "CONCORD",
"state": "CA",
"postal_code": "945204822",
"telephone_number": "925-521-5620",
"fax_number": "925-521-5639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "REVONDA",
"middle_name": "BONITA",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-15",
"last_updated": "2025-10-10",
"certification_date": "2025-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "373H00000X",
"taxonomy_group": "",
"desc": "Day Training/Habilitation Specialist",
"state": "CA",
"license": null,
"primary": true
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "CA",
"license": "MPSS-ILRHOZ",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.