Provider Demographics
NPI:1457612681
Name:PAREJAS, BRENDA (CMF)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:PAREJAS
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3526 DOVETAIL LN N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-4123
Mailing Address - Country:US
Mailing Address - Phone:863-686-6809
Mailing Address - Fax:863-868-6809
Practice Address - Street 1:3526 DOVETAIL LN N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4123
Practice Address - Country:US
Practice Address - Phone:863-686-6809
Practice Address - Fax:863-868-6809
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2017-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLC52003224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter