Healthcare Provider Details

I. General information

NPI: 1336725043
Provider Name (Legal Business Name): JESUS DANIEL MENDEZ CARBAJAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNARD DR
OCEANSIDE CA
92056-3820
US

IV. Provider business mailing address

1 BARNARD DR
OCEANSIDE CA
92056-3820
US

V. Phone/Fax

Practice location:
  • Phone: 760-795-6675
  • Fax:
Mailing address:
  • Phone: 760-795-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC8347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: