Provider Demographics
NPI:1346515475
Name:BENCOMO, MARGO G
Entity Type:Individual
Prefix:MS
First Name:MARGO
Middle Name:G
Last Name:BENCOMO
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 1:3325 VALVERDE LOOP
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-8550
Mailing Address - Country:US
Mailing Address - Phone:575-525-2337
Mailing Address - Fax:575-525-2337
Practice Address - Street 1:3325 VALVERDE LOOP
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-8550
Practice Address - Country:US
Practice Address - Phone:575-525-2337
Practice Address - Fax:575-525-2337
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM008272158172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver