Healthcare Provider Details

I. General information

NPI: 1871456590
Provider Name (Legal Business Name): BRENDA PEDRAZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CAMINO LA COSTA
AUSTIN TX
78752-3930
US

IV. Provider business mailing address

32252 STATE HIGHWAY 100
LOS FRESNOS TX
78566-4328
US

V. Phone/Fax

Practice location:
  • Phone: 512-478-4939
  • Fax:
Mailing address:
  • Phone: 956-408-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number20668
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: