Provider Demographics
NPI:1508208471
Name:BENITEZ, JOAN BENITEZ (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:BENITEZ
Last Name:BENITEZ
Suffix:
Gender:F
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:CELESTA PENTHOUSE 1, CYPRESS TOWERS
Mailing Address - Street 2:C5 ROAD
Mailing Address - City:TAGUIG CITY
Mailing Address - State:MANILA
Mailing Address - Zip Code:16300
Mailing Address - Country:PH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CELESTA PENTHOUSE 1, CYPRESS TOWERS
Practice Address - Street 2:C5 ROAD
Practice Address - City:TAGUIG CITY
Practice Address - State:MANILA
Practice Address - Zip Code:16300
Practice Address - Country:PH
Practice Address - Phone:917-508-2538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GUM-2137208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program