1902909591 NPI number — MRS. BRENDA RIMANDO NARCELLES MD

Table of content: MRS. BRENDA RIMANDO NARCELLES MD (NPI 1902909591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902909591 NPI number — MRS. BRENDA RIMANDO NARCELLES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NARCELLES
Provider First Name:
BRENDA
Provider Middle Name:
RIMANDO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BANEZ
Provider Other First Name:
BRENDA
Provider Other Middle Name:
NARCELLES
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1902909591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7060 W CENTENNIAL DR
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
TINLEY PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-532-2022
Provider Business Mailing Address Fax Number:
708-532-4740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7060 W CENTENNIAL DR
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
TINLEY PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-532-2022
Provider Business Practice Location Address Fax Number:
708-532-4740
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  03644891 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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