Healthcare Provider Details

I. General information

NPI: 1245237197
Provider Name (Legal Business Name): BENIGNO A CABAN GOMEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. JOSE CEDENO 552 ARECIBO MINI PLAZA
ARECIBO PR
00612
US

IV. Provider business mailing address

PO BOX 375
ARECIBO PR
00613-0375
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-2526
  • Fax: 787-880-1587
Mailing address:
  • Phone: 787-878-2526
  • Fax: 787-880-1587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number0491
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: