1740419316 NPI number — BRENDA LYNNE MENCHACA STEPHENS LPCC

Table of content: BRENDA LYNNE MENCHACA STEPHENS LPCC (NPI 1740419316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740419316 NPI number — BRENDA LYNNE MENCHACA STEPHENS LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEPHENS
Provider First Name:
BRENDA
Provider Middle Name:
LYNNE MENCHACA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEPHENS
Provider Other First Name:
BRENDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPCC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1740419316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8775 AERO DR STE 240
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-1756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-304-4852
Provider Business Mailing Address Fax Number:
888-337-3402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8775 AERO DR STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-304-4852
Provider Business Practice Location Address Fax Number:
888-337-3402
Provider Enumeration Date:
07/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  4366 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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