=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144027111
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENITEZ MED SERVICES CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2025
-----------------------------------------------------
Last Update Date | 02/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 CALLE FONT MARTELO E
-----------------------------------------------------
City | HUMACAO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00791-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-636-0915
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 576
-----------------------------------------------------
City | GURABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00778-0576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHRISTIAN J BENITEZ RAMIREZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 787-636-0915
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------