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General NPI Number Information
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NPI Number | 1073200549
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Entity Type | Individual
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Provider Name | BRENDA CABRERA VICENS PA
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Gender | Female
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 425 JACK MARTIN BLVD
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City | BRICK
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State | NJ
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Zip | 08724-7732
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Country | US
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Telephone | 732-202-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 331 NEWMAN SPRINGS RD BLDG 2, STE 220
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City | RED BANK
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State | NJ
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Zip | 07701-5688
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00783500
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00783500
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License Number State | NJ
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