Provider Demographics
NPI:1477551984
Name:HERNANDEZ, BENITO (MD)
Entity Type:Individual
Prefix:
First Name:BENITO
Middle Name:
Last Name:HERNANDEZ
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:PO BOX 8731
Mailing Address - Street 2:CALLE J ESQ. CALLE B OH. 106 EDIL. MED. HNAS DAUILA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8731
Mailing Address - Country:US
Mailing Address - Phone:787-740-0066
Mailing Address - Fax:787-269-3020
Practice Address - Street 1:CALLE J ESQ. CALLE B OH. 106 EDIL. MED. HNAS DAUILA
Practice Address - Street 2:CALLE J ESQ. CALLE B OH. 106 EDIL. MED. HNAS DAUILA
Practice Address - City:BAYAMON
Practice Address - State:OR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-740-0066
Practice Address - Fax:787-269-3020
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5076207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1060OtherINTERNATIONAL MEDICAL CAR
PE0133OtherPALIC
068118OtherSSS
6200077OtherHUMAN HEALTH
6200077OtherHUMANA INSURANCE
068118OtherC.A,
209094OtherUTI
2808OtherAMERICAN HEALTH CARE
1060OtherINTERNATIONAL MEDICAL CAR
6200077OtherHUMANA INSURANCE