Healthcare Provider Details

I. General information

NPI: 1174195069
Provider Name (Legal Business Name): BRENDA JACOBO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 YGNACIO VALLEY RD STE B212
WALNUT CREEK CA
94596-8209
US

IV. Provider business mailing address

675 YGNACIO VALLEY RD STE B212
WALNUT CREEK CA
94596-8209
US

V. Phone/Fax

Practice location:
  • Phone: 510-639-2929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: