Healthcare Provider Details

I. General information

NPI: 1205329802
Provider Name (Legal Business Name): STEFANY MENJIVAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 FAIRMONT DR
SAN LEANDRO CA
94578-1088
US

IV. Provider business mailing address

2045 FAIRMONT DR
CASTRO VALLEY CA
94578-1088
US

V. Phone/Fax

Practice location:
  • Phone: 510-667-7540
  • Fax:
Mailing address:
  • Phone: 510-375-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number129617
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164476
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: