1750964870 NPI number — MR. JUAN PABLO BENABE VIDAL SLP

Table of content: MR. JUAN PABLO BENABE VIDAL SLP (NPI 1750964870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750964870 NPI number — MR. JUAN PABLO BENABE VIDAL SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENABE VIDAL
Provider First Name:
JUAN PABLO
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
SLP
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:
1750964870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 193069
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00919-3069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-761-0036
Provider Business Mailing Address Fax Number:
787-491-0286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PLAZA MONTE REAL SHOPPING CENTER
Provider Second Line Business Practice Location Address:
PR 2 KM 45.6, LOCAL 16
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-884-4629
Provider Business Practice Location Address Fax Number:
787-491-0286
Provider Enumeration Date:
05/05/2021

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: 235Z00000X , with the licence number:  004238 , 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)





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