Healthcare Provider Details

I. General information

NPI: 1457334245
Provider Name (Legal Business Name): BRIGILDA COCOS TENEZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 ROBERT GRANT AVE
SILVER SPRING MD
20910-7500
US

IV. Provider business mailing address

503 ROBERT GRANT AVE
SILVER SPRING MD
20910-7500
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-9184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-10660
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: