Provider Demographics
NPI:1245934041
Name:URQUIJO AREVALO, BRENDA EUGENIA
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:EUGENIA
Last Name:URQUIJO AREVALO
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 1:13020 SW 265TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7818
Mailing Address - Country:US
Mailing Address - Phone:786-668-0970
Mailing Address - Fax:
Practice Address - Street 1:13020 SW 265TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-7818
Practice Address - Country:US
Practice Address - Phone:786-668-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician