=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871945626
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRENDA GARMA PHD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2016
-----------------------------------------------------
Last Update Date | 07/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 VILLAGE SQUARE XING SUITE 2D
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-3227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-315-8849
-----------------------------------------------------
Fax | 561-203-2564
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 VILLAGE SQUARE XING SUITE 2D
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-3227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-315-8849
-----------------------------------------------------
Fax | 561-203-2564
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRENDA GARMA
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 561-315-8849
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | MH7233
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------