Provider Demographics
NPI:1215920863
Name:BENITEZ, OSCAR JESUS (MD)
Entity type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:JESUS
Last Name:BENITEZ
Suffix:
Gender:M
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:PO BOX 7891
Mailing Address - Street 2:PMB 475
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-7891
Mailing Address - Country:US
Mailing Address - Phone:787-783-8081
Mailing Address - Fax:787-783-4235
Practice Address - Street 1:U3-1 CARR 21
Practice Address - Street 2:URB. LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3313
Practice Address - Country:US
Practice Address - Phone:787-783-8081
Practice Address - Fax:787-783-4235
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR43022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR063860OtherCRUZ AZUL
PR96019BEOtherSSS
PRN964OtherINTERNATIONAL MED CARD
PR34302OtherCIGNA
PR4604302OtherUIA
PASE3182OtherPALIC
PR217049OtherUTI PREFERRED HEALTH
PR9260005OtherPCA INSURANCE GROUP
PR4302OtherHOFFA HEALTH CARE
PASE3182OtherPALIC
C84053Medicare UPIN