MEDICARE: WOMEN'S WELLNESS & ANTIAGING MEDICAL SPA,PSC

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	261Q00000X	Clinic/Center	16821	PR

General Provider Information

NPI Number	:	1376902759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMEN'S WELLNESS & ANTIAGING MEDICAL SPA,PSC

Provider Business Mailing Address
First Line	:	PO BOX 70344
Second Line	:	PMB 366
City	:	SAN JUAN
State	:	PR
Zip	:	00936-8344
Country	:	US
Telephone Number	:	787-379-4777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1565 ALDA ST
Second Line	:	URB CARIBE
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-379-4777
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ERIKA MICHELLE BENABE
Credential	:	MD
Telephone Number	:	787-379-4777

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	02/15/2016

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