Provider Demographics
NPI:1780768978
Name:ASENCIO, BRENDALIZ (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDALIZ
Middle Name:
Last Name:ASENCIO
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 1:925 N STONE ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2521
Mailing Address - Country:US
Mailing Address - Phone:386-734-6007
Mailing Address - Fax:
Practice Address - Street 1:925 N STONE ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2521
Practice Address - Country:US
Practice Address - Phone:386-734-6007
Practice Address - Fax:386-734-6008
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14442208D00000X
FLACN430208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBA7975444OtherDEA