Provider Demographics
NPI:1881238582
Name:TENEDORA, MARIA KATRINA ELAINE BANEZ-GLORIA
Entity type:Individual
Prefix:
First Name:MARIA KATRINA ELAINE
Middle Name:BANEZ-GLORIA
Last Name:TENEDORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA KATRINA ELAINE
Other - Middle Name:BANEZ
Other - Last Name:GLORIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:265 UNION ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6715
Mailing Address - Country:US
Mailing Address - Phone:530-304-1407
Mailing Address - Fax:
Practice Address - Street 1:8801 FOLSOM BLVD STE 265
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3250
Practice Address - Country:US
Practice Address - Phone:916-382-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst