Provider Demographics
NPI:1508606526
Name:RENDEROS, MAYRA ALEJANDRA
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:ALEJANDRA
Last Name:RENDEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAYRA
Other - Middle Name:ALEJANDRA
Other - Last Name:TERRERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2706 REIGN ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2465
Mailing Address - Country:US
Mailing Address - Phone:813-240-1218
Mailing Address - Fax:
Practice Address - Street 1:2706 REIGN ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-2465
Practice Address - Country:US
Practice Address - Phone:813-240-1218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9369176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily