Healthcare Provider Details

I. General information

NPI: 1306395140
Provider Name (Legal Business Name): BRENDALY GARCIA MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3326 AVE BOULEVARD TERCERA SECCION URB LEVITTOWN
TOA BAJA PR
00949
US

IV. Provider business mailing address

3326 PASEO CARMEN
TOA BAJA PR
00949-3136
US

V. Phone/Fax

Practice location:
  • Phone: 787-784-7200
  • Fax: 787-761-0613
Mailing address:
  • Phone: 787-784-7200
  • Fax: 787-761-0613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5672
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: