Healthcare Provider Details

I. General information

NPI: 1700799509
Provider Name (Legal Business Name): MISS BRENDA MARTINEZ HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6313 KIMBERLY CT
RIVERBANK CA
95367-3021
US

IV. Provider business mailing address

6313 KIMBERLY CT
RIVERBANK CA
95367-3021
US

V. Phone/Fax

Practice location:
  • Phone: 510-798-5597
  • Fax: 510-798-5597
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberNA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: