Healthcare Provider Details

I. General information

NPI: 1134103187
Provider Name (Legal Business Name): MARITZA BENITEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE MEDICA 1 DOCTORS CENTER HOSPITAL OFICINA 306
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 115 HDS LA MONSERRATE
MANATI PR
00674-0115
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-9697
  • Fax:
Mailing address:
  • Phone: 787-854-5976
  • Fax: 787-862-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7732
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier066893
Identifier TypeOTHER
Identifier State
Identifier IssuerCRUZ AZUL
# 2
Identifier80384BE
Identifier TypeOTHER
Identifier State
Identifier IssuerTRIPLE S

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: