Healthcare Provider Details

I. General information

NPI: 1114833399
Provider Name (Legal Business Name): JOCELYN BEVERLY BRAMBILA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 IRIS AVE
SAN DIEGO CA
92154-3338
US

IV. Provider business mailing address

2710 IRIS AVE
SAN DIEGO CA
92154-3338
US

V. Phone/Fax

Practice location:
  • Phone: 619-628-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: