Healthcare Provider Details

I. General information

NPI: 1346894391
Provider Name (Legal Business Name): BRENDA MELENDREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9916 CENTRAL AVE
MONTCLAIR CA
91763-3201
US

IV. Provider business mailing address

888 S VINE AVE
RIALTO CA
92376-8308
US

V. Phone/Fax

Practice location:
  • Phone: 909-450-2502
  • Fax: 909-450-2637
Mailing address:
  • Phone: 323-359-5302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: