Provider Demographics
NPI:1952599490
Name:HAMER, BRENDA KAY (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA KAY
Middle Name:
Last Name:HAMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRENDRA
Other - Middle Name:KAY
Other - Last Name:FIDALEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:FILE # 54433
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-4433
Mailing Address - Country:US
Mailing Address - Phone:858-784-5888
Mailing Address - Fax:
Practice Address - Street 1:7425 MISSION VALLEY RD
Practice Address - Street 2:STE 202 MCS91
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4409
Practice Address - Country:US
Practice Address - Phone:619-245-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107846208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics