Provider Demographics
NPI:1053082560
Name:DELGADO PARDO, BRENDA (COTA)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:DELGADO PARDO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 NW 11TH ST APT 227
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2235
Mailing Address - Country:US
Mailing Address - Phone:305-764-0833
Mailing Address - Fax:
Practice Address - Street 1:1170 NW 11TH ST APT 227
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2235
Practice Address - Country:US
Practice Address - Phone:305-764-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18591224Z00000X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant