Healthcare Provider Details

I. General information

NPI: 1093577165
Provider Name (Legal Business Name): BRANDON AGUSTIN MENDEZ GARFIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 FIFTH AVE
SAN DIEGO CA
92103-2105
US

IV. Provider business mailing address

155 LAS FLORES DR SPC 91
SAN MARCOS CA
92069-6011
US

V. Phone/Fax

Practice location:
  • Phone: 858-832-2478
  • Fax:
Mailing address:
  • Phone: 760-672-1708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00944123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: