Provider Demographics
NPI:1033595004
Name:JAQUEZ, BRIANDA
Entity Type:Individual
Prefix:
First Name:BRIANDA
Middle Name:
Last Name:JAQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 VISTA SERENA LN SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-8993
Mailing Address - Country:US
Mailing Address - Phone:505-948-6483
Mailing Address - Fax:
Practice Address - Street 1:7510 MONTGOMERY BLVD NE STE 202
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1500
Practice Address - Country:US
Practice Address - Phone:505-948-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health