Provider Demographics
NPI:1528509734
Name:BENGOA, MELISSA M (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:M
Last Name: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 1:925 NE 30TH TER STE 210
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7614
Mailing Address - Country:US
Mailing Address - Phone:305-248-9488
Mailing Address - Fax:305-248-9557
Practice Address - Street 1:925 NE 30TH TER STE 210
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7614
Practice Address - Country:US
Practice Address - Phone:305-248-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009544207R00000X
FL390200000X
FLME149351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program