Provider Demographics
NPI:1003343773
Name:BENABE CARLO, JOSUE ALEXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSUE
Middle Name:ALEXIS
Last Name:BENABE CARLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CALLE GUAYACAN
Mailing Address - Street 2:URB. MANSIONES DE LOS ARTESANOS
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771
Mailing Address - Country:US
Mailing Address - Phone:787-390-5519
Mailing Address - Fax:
Practice Address - Street 1:124 CALLE GUAYACAN
Practice Address - Street 2:URB. MANSIONES DE LOS ARTESANOS
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-390-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21150208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program