Healthcare Provider Details

I. General information

NPI: 1215920863
Provider Name (Legal Business Name): OSCAR JESUS BENITEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 03/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U3-1 CARR 21 URB. LAS LOMAS
SAN JUAN PR
00921-3313
US

IV. Provider business mailing address

PO BOX 7891 PMB 475
GUAYNABO PR
00970-7891
US

V. Phone/Fax

Practice location:
  • Phone: 787-783-8081
  • Fax: 787-783-4235
Mailing address:
  • Phone: 787-783-8081
  • Fax: 787-783-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4302
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: