Healthcare Provider Details

I. General information

NPI: 1023183944
Provider Name (Legal Business Name): MRS. MIGDALIA BENEJAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE BARBOSA 151
MOCA PR
00676
US

IV. Provider business mailing address

CALLE DEL PILAR 447 URB LA MONSERRATE
MOCA PR
00676
US

V. Phone/Fax

Practice location:
  • Phone: 787-877-8100
  • Fax: 787-877-6180
Mailing address:
  • Phone: 787-877-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number4890
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: