Healthcare Provider Details

I. General information

NPI: 1225575673
Provider Name (Legal Business Name): BRENDA LY TORRES CARABALLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9343 TECH CENTER DR STE 110
SACRAMENTO CA
95826-2592
US

IV. Provider business mailing address

18225 HALE AVE
MORGAN HILL CA
95037-3547
US

V. Phone/Fax

Practice location:
  • Phone: 916-379-5876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF100540
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: