Provider Demographics
NPI:1477064756
Name:MENDEZ, BRENDA REYNA (9489 - R)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:REYNA
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:9489 - R
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:REYNA
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2180 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4558
Mailing Address - Country:US
Mailing Address - Phone:805-473-7080
Mailing Address - Fax:805-473-7188
Practice Address - Street 1:2180 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4558
Practice Address - Country:US
Practice Address - Phone:805-473-7080
Practice Address - Fax:805-473-7188
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9489-R101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional