Provider Demographics
NPI:1235640319
Name:LIU, BRENDA NGUYEN
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:NGUYEN
Last Name:LIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8375 NW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4611
Mailing Address - Country:US
Mailing Address - Phone:305-243-8644
Mailing Address - Fax:
Practice Address - Street 1:8375 NW 53RD ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-4611
Practice Address - Country:US
Practice Address - Phone:305-243-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant