Provider Demographics
NPI:1629543632
Name:PINON, BRENDA LETICIA (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LETICIA
Last Name:PINON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14385 CLEO AMELIA LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-7301
Mailing Address - Country:US
Mailing Address - Phone:915-667-4465
Mailing Address - Fax:
Practice Address - Street 1:14385 CLEO AMELIA LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-7301
Practice Address - Country:US
Practice Address - Phone:915-667-4465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX917288163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse