=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861290686
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. BRENDA ZAMORA FERNANDEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2025
-----------------------------------------------------
Last Update Date | 03/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21013 SHERMAN WAY STE 4
-----------------------------------------------------
City | CANOGA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-3675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-887-9697
-----------------------------------------------------
Fax | 818-887-9495
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22900 OAK RIDGE DR APT 65
-----------------------------------------------------
City | SANTA CLARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91350-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-478-9706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | APCC18843
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------