Provider Demographics
NPI:1801994066
Name:BRENDA AMADOR
Entity type:Organization
Organization Name:BRENDA AMADOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-782-8222
Mailing Address - Street 1:806 W. BUS. 83 STE. H
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3444
Mailing Address - Country:US
Mailing Address - Phone:956-782-8222
Mailing Address - Fax:956-782-8223
Practice Address - Street 1:806 W. BUS. 83 STE. H
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3444
Practice Address - Country:US
Practice Address - Phone:956-782-8222
Practice Address - Fax:956-782-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0091836332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183610802Medicaid
TX5796130001Medicare NSC