Individual
MISS BRENDA CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
5555 RESERVOIR DR STE 204, SAN DIEGO, CA 92120
(858) 573-2600
Mailing address
5555 RESERVOIR DR STE 204, SAN DIEGO, CA 92120-5137
(858) 573-2600
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
103T00000X
Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558687244
—
CA
Enumeration date
04/20/2010
Last updated
05/29/2019
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