Provider Demographics
NPI:1750651964
Name:TEIXEIRA, BRENO (CRNA)
Entity type:Individual
Prefix:
First Name:BRENO
Middle Name:
Last Name:TEIXEIRA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6296
Mailing Address - Country:US
Mailing Address - Phone:305-778-7295
Mailing Address - Fax:
Practice Address - Street 1:2424 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6296
Practice Address - Country:US
Practice Address - Phone:305-778-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144371367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered