Healthcare Provider Details

I. General information

NPI: 1316148067
Provider Name (Legal Business Name): BRENDA I MORA RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SUR CALLE CORCHADO ESQUINA NUNEZ ROMEU
CAYEY PR
00736
US

IV. Provider business mailing address

PO BOX 4960 PMB 413
CAGUAS PR
00726
US

V. Phone/Fax

Practice location:
  • Phone: 787-738-7455
  • Fax: 787-535-7505
Mailing address:
  • Phone: 787-738-7455
  • Fax: 787-535-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number14891
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number14891
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14891
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: