Provider Demographics
NPI:1417384066
Name:AVALOS, BRENDA NINETH
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:NINETH
Last Name:AVALOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 TECH CENTER DR STE 160
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2590
Mailing Address - Country:US
Mailing Address - Phone:916-457-1900
Mailing Address - Fax:916-457-4439
Practice Address - Street 1:9300 TECH CENTER DR STE 160
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2590
Practice Address - Country:US
Practice Address - Phone:916-457-1900
Practice Address - Fax:916-457-4439
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator