Healthcare Provider Details

I. General information

NPI: 1083549224
Provider Name (Legal Business Name): BRENMARIS AGOSTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 2 BOX 7731
COROZAL PR
00783-6015
US

IV. Provider business mailing address

HC 2 BOX 7731
COROZAL PR
00783-6015
US

V. Phone/Fax

Practice location:
  • Phone: 939-630-5523
  • Fax:
Mailing address:
  • Phone: 939-630-5523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1102-1
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: