Provider Demographics
NPI:1124075429
Name:PALMER BENGOA, JUDITH TERESA (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:TERESA
Last Name:PALMER BENGOA
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:COND ST MARYS PLAZA
Mailing Address - Street 2:TORRE SUR APT. 1601
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-530-0888
Mailing Address - Fax:787-754-1059
Practice Address - Street 1:COND. ST. MARYS PLAZA
Practice Address - Street 2:TORRE SUR , APT. 1601
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-530-0888
Practice Address - Fax:787-754-1059
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14006208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22270Medicare ID - Type Unspecified