Healthcare Provider Details

I. General information

NPI: 1265988455
Provider Name (Legal Business Name): BRENDA CARDOZO PLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA M APARICIO

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 INDUSTRIAL PARK RD
ESPANOLA NM
87532-3600
US

IV. Provider business mailing address

PO BOX 158 ATTN: CREDENTIALING
ESPANOLA NM
87532-0158
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-7395
  • Fax:
Mailing address:
  • Phone: 505-753-7218
  • Fax: 505-747-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-09659
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: