MEDICARE: BENJAMIN JOSEPH SOMARRIBA

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	163W00000X	Registered Nurse	9343400	FL

General Provider Information

NPI Number	:	1831935212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN JOSEPH SOMARRIBA

Provider Business Mailing Address
First Line	:	6420 SW 138TH CT APT 103
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-2259
Country	:	US
Telephone Number	:	786-515-8964
Fax Number	:

Provider Business Practice Location Address
First Line	:	6420 SW 138TH CT APT 103
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-2259
Country	:	US
Telephone Number	:	786-515-8964
Fax Number	:

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

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	07/03/2024

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