Provider Demographics
NPI:1720528540
Name:PENA, BRENDA ORTIZ
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:ORTIZ
Last Name:PENA
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 1:15 RAMSDELL PL
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2724
Mailing Address - Country:US
Mailing Address - Phone:857-251-4488
Mailing Address - Fax:
Practice Address - Street 1:6 KIMBALL LN
Practice Address - Street 2:SUITE 310
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2682
Practice Address - Country:US
Practice Address - Phone:781-246-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker