Provider Demographics
NPI:1790654937
Name:BENITEZ SANTANA MED GROUP LLC
Entity type:Organization
Organization Name:BENITEZ SANTANA MED GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENITEZ SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-981-0299
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0576
Mailing Address - Country:US
Mailing Address - Phone:787-981-0299
Mailing Address - Fax:
Practice Address - Street 1:174 CALLE LUIS BARRERAS S
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4615
Practice Address - Country:US
Practice Address - Phone:787-981-0299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty