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General NPI Number Information
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NPI Number | 1659359420
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Entity Type | Individual
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Provider Name | BENJAMIN NMN MENA MD
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Gender | Male
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2835 W DE LEON ST SUITE 104
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City | TAMPA
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State | FL
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Zip | 33609-4130
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Country | US
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Telephone | 813-443-0606
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Fax | 813-443-0608
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Provider Business Mailing Address
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Address Line | 2835 W DE LEON ST SUITE 104
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City | TAMPA
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State | FL
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Zip | 33609-4130
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Country | US
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Telephone | 813-443-0606
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Fax | 813-443-0608
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME98740
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License Number State | FL
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