Healthcare Provider Details

I. General information

NPI: 1114109196
Provider Name (Legal Business Name): BRENDA OJEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C GUARIONEZ LOCAL 7
HATO REY PR
00917
US

IV. Provider business mailing address

C/ GUARIONEX LOCAL 7
HATO REY PR
00917
US

V. Phone/Fax

Practice location:
  • Phone: 787-281-7314
  • Fax:
Mailing address:
  • Phone: 787-281-7314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number17849
License Number StatePR

VII. Legacy identifiers

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

# 1
Identifier17849
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerSTATE MEDICAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: