Provider Demographics
NPI:1073098794
Name:CHAPMAN BENNETT, LUSILLDA REBECA
Entity Type:Individual
Prefix:
First Name:LUSILLDA
Middle Name:REBECA
Last Name:CHAPMAN BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 CORAL WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1684
Mailing Address - Country:US
Mailing Address - Phone:305-220-3700
Mailing Address - Fax:
Practice Address - Street 1:7171 CORAL WAY STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1684
Practice Address - Country:US
Practice Address - Phone:305-270-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9421327207Q00000X
FLARNP9421327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine