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General NPI Number Information
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NPI Number | 1982634135
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Entity Type | Individual
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Provider Name | LARISSA M COLON-BENGOA MD
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Gender | Female
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 1901 S CONGRESS AVE STE 420
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-6588
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Country | US
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Telephone | 561-364-1479
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Fax |
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Provider Business Mailing Address
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Address Line | 20036 SE BRIDGEWATER DR
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City | JUPITER
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State | FL
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Zip | 33458-1651
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Country | US
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Telephone | 561-676-8109
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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 | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | ME87982
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME87982
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License Number State | FL
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