Provider Demographics
NPI:1194131367
Name:BRENDA AGUAYO PCP
Entity type:Organization
Organization Name:BRENDA AGUAYO PCP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERALISTA
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:AGUAYO
Authorized Official - Last Name:VICENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-855-0586
Mailing Address - Street 1:PO BOX 1097
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:#29-B CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-855-0586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14441261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1326138132OtherNPI