MEDICARE: JUAN CARLOS BENAVIDES PA

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	363A00000X	Physician Assistant	2517	PR

General Provider Information

NPI Number	:	1881480077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN CARLOS BENAVIDES PA

Provider Business Mailing Address
First Line	:	3178 AZOLLA ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-3908
Country	:	US
Telephone Number	:	386-215-0973
Fax Number	:

Provider Business Practice Location Address
First Line	:	3178 AZOLLA ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-3908
Country	:	US
Telephone Number	:	386-215-0973
Fax Number	:

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

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	04/16/2025

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Directions to “ JUAN CARLOS BENAVIDES PA” Practice Location

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