Provider Demographics
NPI:1457171274
Name:HERNANDEZ BENEJAM, LYANN JENNIFER
Entity type:Individual
Prefix:
First Name:LYANN
Middle Name:JENNIFER
Last Name:HERNANDEZ BENEJAM
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:PO BOX 3018
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3018
Mailing Address - Country:US
Mailing Address - Phone:939-224-7249
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 3018
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605-3018
Practice Address - Country:US
Practice Address - Phone:939-224-7249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty