Provider Demographics
NPI:1760842694
Name:BERENGUER, WANDA
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:BERENGUER
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 1:1850 MUSCAT CT
Mailing Address - Street 2:APT G
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-3457
Mailing Address - Country:US
Mailing Address - Phone:787-627-2826
Mailing Address - Fax:
Practice Address - Street 1:1850 MUSCAT CT
Practice Address - Street 2:APT G
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3457
Practice Address - Country:US
Practice Address - Phone:787-627-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program