1720809502 NPI number — MISS JENNIFER EMILIA AVENDANO MS, AMFT

Table of content: MISS JENNIFER EMILIA AVENDANO MS, AMFT (NPI 1720809502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720809502 NPI number — MISS JENNIFER EMILIA AVENDANO MS, AMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVENDANO
Provider First Name:
JENNIFER
Provider Middle Name:
EMILIA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MS, AMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720809502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8300 ESTERS BLVD STE 900
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75063-2233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-424-4266
Provider Business Mailing Address Fax Number:
415-520-6633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10775 PIONEER TRL
Provider Second Line Business Practice Location Address:
#215
Provider Business Practice Location Address City Name:
TRUCKEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-424-4266
Provider Business Practice Location Address Fax Number:
415-520-6633
Provider Enumeration Date:
10/23/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  150040 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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