Provider Demographics
NPI:1427801182
Name:SOTO FUENTES, BRENDA ARANZAZU
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ARANZAZU
Last Name:SOTO FUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 SWARM CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-1036
Mailing Address - Country:US
Mailing Address - Phone:615-853-0156
Mailing Address - Fax:
Practice Address - Street 1:5203 MARYLAND WAY STE 104
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5022
Practice Address - Country:US
Practice Address - Phone:615-560-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician