Provider Demographics
NPI:1902699432
Name:ALINA, MARIA ANNA AVELLANEDA
Entity type:Individual
Prefix:
First Name:MARIA ANNA
Middle Name:AVELLANEDA
Last Name:ALINA
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 1:33059 ARIZONA ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3149
Mailing Address - Country:US
Mailing Address - Phone:209-684-3710
Mailing Address - Fax:
Practice Address - Street 1:4991 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-2006
Practice Address - Country:US
Practice Address - Phone:208-439-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-22-208253106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician