=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043316185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORBEN PHYSICIANS P.S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | B1 CALLE TOMAS AGRAIT CLUB MANOR VILLAGE
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00924-4350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-757-7956
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | B1 CALLE TOMAS AGRAIT CLUB MANOR VILLAGE
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00924-4350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-757-7956
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ERIKA MICHELLE BENABE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 787-644-5230
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------