Provider Demographics
NPI:1245511526
Name:GOVEA, BRENDA ALEJANDRA
Entity type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:ALEJANDRA
Last Name:GOVEA
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 1:735 N D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1111
Mailing Address - Country:US
Mailing Address - Phone:909-381-5507
Mailing Address - Fax:909-888-5938
Practice Address - Street 1:735 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1111
Practice Address - Country:US
Practice Address - Phone:909-381-5507
Practice Address - Fax:909-888-5938
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3646Medicaid