1578568598 NPI number — DR. CARLOS F BENITEZ D.M.D.

Table of content: DR. CARLOS F BENITEZ D.M.D. (NPI 1578568598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578568598 NPI number — DR. CARLOS F BENITEZ D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENITEZ
Provider First Name:
CARLOS
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578568598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 AVE TITO CASTRO
Provider Second Line Business Mailing Address:
PMB 349
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00716-0206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-841-1419
Provider Business Mailing Address Fax Number:
787-841-1419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 AVE TITO CASTRO
Provider Second Line Business Practice Location Address:
PMB 349
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716-0206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-841-1419
Provider Business Practice Location Address Fax Number:
787-841-1419
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  1702 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41573 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 041348 . This is a "BLUE CROSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 206384 . This is a "UTI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7310230 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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