Provider Demographics
NPI:1306056197
Name:LOPEZ-RODRIGUEZ, BRENDA L (PHL)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:LOPEZ-RODRIGUEZ
Suffix:
Gender:F
Credentials:PHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HACIENDAS DE CARRAIZO
Mailing Address - Street 2:CALLE 5 H 6
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9143
Mailing Address - Country:US
Mailing Address - Phone:939-969-2773
Mailing Address - Fax:787-748-8761
Practice Address - Street 1:RAMAL 199
Practice Address - Street 2:CAMINO LOS BAEZ- SECTOR LOS GARCIA
Practice Address - City:GUAYNBO
Practice Address - State:PR
Practice Address - Zip Code:00969-1445
Practice Address - Country:US
Practice Address - Phone:787-287-7030
Practice Address - Fax:787-287-4880
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR651235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist