Provider Demographics
NPI:1083837025
Name:BENABE HUERTAS, IVONNE I
Entity Type:Individual
Prefix:DR
First Name:IVONNE
Middle Name:I
Last Name:BENABE HUERTAS
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:PO BOX 875
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-0875
Mailing Address - Country:US
Mailing Address - Phone:787-376-5415
Mailing Address - Fax:787-889-7001
Practice Address - Street 1:J6 CALLE 2
Practice Address - Street 2:BRISAS DEL MAR
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-2471
Practice Address - Country:US
Practice Address - Phone:787-376-5415
Practice Address - Fax:787-889-7001
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12328208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002-0268Medicare PIN