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General NPI Number Information
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NPI Number | 1144840323
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Entity Type | Organization
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Legal Business Name | FBC MENTAL LLC
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Dates
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Enumeration Date | 04/17/2020
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Last Update Date | 04/17/2020
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Provider Practice Location Address
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Address Line | CARR 21 S 3 # 11 SUITE 304 LAS LOMAS
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City | SAN JUAN
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State | PR
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Zip | 00921-0092
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Country | US
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Telephone | 787-949-7050
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Fax |
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Provider Business Mailing Address
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Address Line | 3071 AVE ALEJANDRINO PMB 231
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City | GUAYNABO
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State | PR
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Zip | 00969
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRANK HERNAND BENITEZ CRUZ
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Credential | MD
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Telephone | 787-949-7050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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