Healthcare Provider Details

I. General information

NPI: 1124686928
Provider Name (Legal Business Name): JESSICA BENITEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA BENITEZ RN

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMM PLAZA BECHARA INDUSTRIAL PARK 411 MARGINAL AVE KENNEDY
SAN JUAN PR
00920
US

IV. Provider business mailing address

PO BOX 71500
SAN JUAN PR
00936-8600
US

V. Phone/Fax

Practice location:
  • Phone: 787-633-2000
  • Fax:
Mailing address:
  • Phone: 787-633-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number78004
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: