Healthcare Provider Details

I. General information

NPI: 1174749709
Provider Name (Legal Business Name): BRENDA E FALCON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AJ16 CALLE SONIA VILLA RICA
BAYAMON PR
00959-4918
US

IV. Provider business mailing address

HC 69 BOX 15674
BAYAMON PR
00956-9519
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-5487
  • Fax:
Mailing address:
  • Phone: 787-798-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5885
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: