Provider Demographics
NPI:1992784920
Name:STIXRUD, BENJAMIN (HS, AMS, NREMT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:STIXRUD
Suffix:
Gender:M
Credentials:HS, AMS, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 GUARD RD
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-1304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:260 GUARD RD
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-1304
Practice Address - Country:US
Practice Address - Phone:787-890-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK02182001146M00000X
PRB1391377146N00000X
171000000X, 246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered171000000XOther Service ProvidersMilitary Health Care Provider
Not Answered246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other