Provider Demographics
NPI:1902398308
Name:MEJIA ESPINOSA, BRENDA SORAYA
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SORAYA
Last Name:MEJIA ESPINOSA
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 1:3225 BLUE MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-4702
Mailing Address - Country:US
Mailing Address - Phone:408-561-5348
Mailing Address - Fax:
Practice Address - Street 1:3225 BLUE MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-4702
Practice Address - Country:US
Practice Address - Phone:408-561-5348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst