Provider Demographics
NPI:1962597203
Name:BENITEZ, NOEMI (MD)
Entity type:Individual
Prefix:DR
First Name:NOEMI
Middle Name:
Last Name:BENITEZ
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:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0400
Mailing Address - Country:US
Mailing Address - Phone:787-843-0665
Mailing Address - Fax:787-834-0666
Practice Address - Street 1:55 CALLE MEDITACION STE 4A
Practice Address - Street 2:CENTRO DE SERVICIOS MEDICOS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4848
Practice Address - Country:US
Practice Address - Phone:787-834-0665
Practice Address - Fax:787-834-0666
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9680174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-1982Medicare ID - Type Unspecified