Provider Demographics
NPI:1336599570
Name:MEMORY DAYBYDAY
Entity Type:Organization
Organization Name:MEMORY DAYBYDAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUKETTA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:510-876-5880
Mailing Address - Street 1:111 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1948
Mailing Address - Country:US
Mailing Address - Phone:510-876-5880
Mailing Address - Fax:510-876-5885
Practice Address - Street 1:111 JACKSON ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1948
Practice Address - Country:US
Practice Address - Phone:510-876-5880
Practice Address - Fax:510-876-5885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-19
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408641251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251S00000XAgenciesCommunity/Behavioral Health