Provider Demographics
NPI:1770897209
Name:BARRERA, BRENDA
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BARRERA
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 1:3400 N MCCOLL RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5787
Mailing Address - Country:US
Mailing Address - Phone:956-627-2508
Mailing Address - Fax:956-627-3751
Practice Address - Street 1:3400 N MCCOLL RD STE 4
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5787
Practice Address - Country:US
Practice Address - Phone:956-972-0400
Practice Address - Fax:956-627-3751
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicare PIN