=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114636412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOUISE M. BENVENUTO, M.D., P.L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2022
-----------------------------------------------------
Last Update Date | 11/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2532 OKEECHOBEE BLVD
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-712-7888
-----------------------------------------------------
Fax | 561-697-4445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2532 OKEECHOBEE BLVD
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-712-7888
-----------------------------------------------------
Fax | 561-697-4445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN PROVIDER
-----------------------------------------------------
Name | DR. LOUISE MARY BENVENUTO M.D.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-214-1462
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------