Healthcare Provider Details

I. General information

NPI: 1588864060
Provider Name (Legal Business Name): ALEXANDER JOSEPH BENJUMEA L.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 STATE ROAD 436 SUITE 251
WINTER PARK FL
32792-2228
US

IV. Provider business mailing address

1100 POINTE NEWPORT TER APT 112
CASSELBERRY FL
32707-7246
US

V. Phone/Fax

Practice location:
  • Phone: 407-657-5029
  • Fax: 407-657-6320
Mailing address:
  • Phone: 407-657-5029
  • Fax: 407-657-6320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA33653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: