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General NPI Number Information
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NPI Number | 1447316393
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Entity Type | Individual
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Provider Name | WANDA I BENITEZ LOPEZ MD
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Gender | Female
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 05/03/2013
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Provider Practice Location Address
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Address Line | QUINTAS DE SANTA MARIA 715
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City | MAYAGUEZ
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State | PR
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Zip | 00682-7496
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Country | US
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Telephone | 787-265-2471
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Fax |
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Provider Business Mailing Address
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Address Line | QUINTAS DE SANTA MARIA 715
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City | MAYAGUEZ
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State | PR
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Zip | 00682-7496
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Country | US
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Telephone | 787-265-2471
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 6863
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | R6E72
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | R3810
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License Number State | AR
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