Provider Demographics
NPI: | 1629622295 |
---|---|
Name: | REYES MEMBRENO, AMERICA BRIGET |
Entity Type: | Individual |
Prefix: | |
First Name: | AMERICA |
Middle Name: | BRIGET |
Last Name: | REYES MEMBRENO |
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: | 1400 N JOHNSON AVE STE 101 |
Mailing Address - Street 2: | |
Mailing Address - City: | EL CAJON |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92020-1651 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1400 N JOHNSON AVE STE 101 |
Practice Address - Street 2: | |
Practice Address - City: | EL CAJON |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92020-1651 |
Practice Address - Country: | US |
Practice Address - Phone: | 617-889-4860 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2019-07-31 |
Last Update Date: | 2024-03-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No | 146D00000X | Emergency Medical Service Providers | Personal Emergency Response Attendant | |
No | 146L00000X | Emergency Medical Service Providers | Emergency Medical Technician, Paramedic | |
No | 146M00000X | Emergency Medical Service Providers | Emergency Medical Technician, Intermediate | |
No | 146N00000X | Emergency Medical Service Providers | Emergency Medical Technician, Basic | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | |
No | 225800000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Recreation Therapist | |
No | 226000000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Recreational Therapist Assistant | |
No | 376K00000X | Nursing Service Related Providers | Nurse's Aide |