MEDICARE: DR. ELIEZER BENERO-NATAL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	6036	PR

General Provider Information

NPI Number	:	1316939648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIEZER BENERO-NATAL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 192494
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-2494
Country	:	US
Telephone Number	:	787-758-3780
Fax Number	:	787-758-3780

Provider Business Practice Location Address
First Line	:	564A CALLE JUAN J JIMENEZ
Second Line	:	PARQUE CENTRAL
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3722
Country	:	US
Telephone Number	:	787-758-3780
Fax Number	:	787-758-3780

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/08/2007

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