Provider Demographics
NPI:1811224777
Name:CORPUZ-CARR, BRENDA (MSN)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:CORPUZ-CARR
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2245
Mailing Address - Country:US
Mailing Address - Phone:805-473-7055
Mailing Address - Fax:805-474-7473
Practice Address - Street 1:286 S 16TH ST
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2245
Practice Address - Country:US
Practice Address - Phone:805-473-7055
Practice Address - Fax:805-474-7473
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530705163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health