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General NPI Number Information
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NPI Number | 1154163004
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Entity Type | Individual
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Provider Name | SUSAN BENCOMO
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Gender | Female
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Dates
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Enumeration Date | 06/11/2024
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 2150 W 76TH ST STE 117
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City | HIALEAH
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State | FL
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Zip | 33016-1887
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Country | US
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Telephone | 786-636-6952
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Fax |
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Provider Business Mailing Address
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Address Line | 6800 W 16TH DR APT 304
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City | HIALEAH
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State | FL
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Zip | 33014-4454
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Country | US
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Telephone | 786-326-0703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11033215
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License Number State | FL
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