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NPI Code Detail

MEDICARE: ANGELICA MARIA SANTANA AVALOS

MEDICARE: ANGELICA MARIA SANTANA AVALOS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator
3106S00000XBehavior Technician

General Provider Information

NPI Number : 1043426224
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELICA MARIA SANTANA AVALOS
Provider Business Mailing Address
First Line : 425 OAK STREET
Second Line :
City : BRENTWOOD
State : CA
Zip : 94513-0456
Country : US
Telephone Number : 925-524-0776
Fax Number :
Provider Business Practice Location Address
First Line : 1200 CONCORD AVE STE 100
Second Line :
City : CONCORD
State : CA
Zip : 94520-4969
Country : US
Telephone Number : 510-832-4383
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 01/08/2021

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Directions to “ ANGELICA MARIA SANTANA AVALOS ” Practice Location

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