Provider Demographics
NPI:1164673513
Name:CONCEPCION, BRENDA LIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:LIZ
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 RR 12
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9608
Mailing Address - Country:US
Mailing Address - Phone:787-513-3667
Mailing Address - Fax:
Practice Address - Street 1:1069 RR 12
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9608
Practice Address - Country:US
Practice Address - Phone:787-513-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17,230208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice