Provider Demographics
NPI:1275635500
Name:BENITEZ-QUINONES, ARELIS (MD)
Entity Type:Individual
Prefix:
First Name:ARELIS
Middle Name:
Last Name:BENITEZ-QUINONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ARELIS
Other - Middle Name:
Other - Last Name:BENITEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:210 1ST STREET, P.O. BOX 290
Mailing Address - Street 2:
Mailing Address - City:WANBLEE
Mailing Address - State:SD
Mailing Address - Zip Code:57577
Mailing Address - Country:US
Mailing Address - Phone:605-462-5650
Mailing Address - Fax:605-462-6631
Practice Address - Street 1:210 1ST STREET
Practice Address - Street 2:
Practice Address - City:WANBLEE
Practice Address - State:SD
Practice Address - Zip Code:57577
Practice Address - Country:US
Practice Address - Phone:605-462-5650
Practice Address - Fax:605-462-6631
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5540040Medicaid
PR15481OtherLICENSE
PHS000OtherUPIN