Provider Demographics
NPI:1033166806
Name:BENGOA, MILTON RODRIGO (M D)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:RODRIGO
Last Name:BENGOA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 NE 30TH TER STE 210
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7614
Mailing Address - Country:US
Mailing Address - Phone:305-248-9488
Mailing Address - Fax:305-248-9557
Practice Address - Street 1:925 NE 30TH TER
Practice Address - Street 2:SUITE 210
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7613
Practice Address - Country:US
Practice Address - Phone:305-248-9488
Practice Address - Fax:305-248-9557
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG12634Medicare UPIN