Provider Demographics
NPI:1033289939
Name:VALLEJO-BENNETT, CARLOS E (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:E
Last Name:VALLEJO-BENNETT
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:M31 CALLE WILSON
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3950
Mailing Address - Country:US
Mailing Address - Phone:787-948-1350
Mailing Address - Fax:
Practice Address - Street 1:AVE. LUIS MUNOZ MARIN
Practice Address - Street 2:HIMA PLAZA I SUITE 312
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-961-4668
Practice Address - Fax:787-961-4674
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine