Mentors Driving Change for Boys, Men and Dads

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

MENTORS DRIVING CHANGE FOR BOYS, MEN AND DADS

Practice address

15 Madison St
Watsonville, CA 95076-4490

Phone

(831) 588-7592

NPI assigned

Dec 13, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Deutron Kebebew

Title

Executive Director/Program Director

Phone

(831) 588-7592

Specialties & licenses 2

Addresses

Other names 1

• MENtors Driving Change for Boys, Men and Dads Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702425600000",
    "number": "1033987631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1585",
            "city": "FREEDOM",
            "state": "CA",
            "postal_code": "950191585",
            "telephone_number": "831-588-7592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 MADISON ST",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950764490",
            "telephone_number": "831-588-7592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTORS DRIVING CHANGE FOR BOYS, MEN AND DADS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-13",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A",
        "authorized_official_last_name": "KEBEBEW",
        "authorized_official_first_name": "DEUTRON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "831-588-7592"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MENtors Driving Change for Boys, Men and Dads",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Alvaro Melgoza
• Melissa Lopez-Bermejo, MD
• Marcio Melo, NP
• Yazmin Mendez
• Mark Mendiola, PHARMD
• Matt Merrill
• Adriana Patricia Mesa, DPT, MS, OCS
• Emily Messa
• Alice Marie Mestemacher, LICENSED MARRIGE FAM
• Teagan Meyer

• Community/Behavioral Health Agency in Watsonville, CA
• Providers in Watsonville, CA by specialty
• Community/Behavioral Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.