Provider Demographics
NPI:1629622295
Name:REYES-MEMBRENO, AMERICA BRIGET (SUDRC)
Entity type:Individual
Prefix:
First Name:AMERICA
Middle Name:BRIGET
Last Name:REYES-MEMBRENO
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N JOHNSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 N JOHNSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1651
Practice Address - Country:US
Practice Address - Phone:617-889-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 146D00000X, 146L00000X, 146M00000X, 146N00000X, 171M00000X, 225800000X, 226000000X, 376K00000X
CA17573101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist Assistant
No376K00000XNursing Service Related ProvidersNurse's Aide