Provider Demographics
NPI:1366575508
Name:CARAZO, BRENDA S (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:CARAZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9449
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9449
Mailing Address - Country:US
Mailing Address - Phone:787-746-8715
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL SAN JUAN BAUTISTA CARRETERA 172
Practice Address - Street 2:URB. TURABO GARDEN
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-5890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC-82015Medicare UPIN
PR2-9086Medicare ID - Type Unspecified