Healthcare Provider Details

I. General information

NPI: 1528214871
Provider Name (Legal Business Name): MONICA VIAL BENSON, M.D., APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 POST DRIVE
LULING LA
70070
US

IV. Provider business mailing address

PO BOX 481
LULING LA
70070-0481
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-6204
  • Fax: 985-785-6509
Mailing address:
  • Phone: 985-785-6204
  • Fax: 985-785-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number013753
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number013753
License Number StateLA

VIII. Authorized Official

Name: MONICA VIAL BENSON
Title or Position: M.D.
Credential: M.D.
Phone: 985-785-6204