Healthcare Provider Details

I. General information

NPI: 1245541028
Provider Name (Legal Business Name): MRS. BRENDALYS NORMANDIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83-4 CALLE 70
BAYAMON PR
00961-4539
US

IV. Provider business mailing address

83-4 CALLE 70
BAYAMON PR
00961-4539
US

V. Phone/Fax

Practice location:
  • Phone: 787-533-5948
  • Fax:
Mailing address:
  • Phone: 787-533-5948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8177
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: