Provider Demographics
NPI:1558422915
Name:BENMAMAN GARZON, MOISES (MD)
Entity Type:Individual
Prefix:MR
First Name:MOISES
Middle Name:
Last Name:BENMAMAN GARZON
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 1:2 VILLA ESTE
Mailing Address - Street 2:DORADO DEL MAR
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-796-2273
Mailing Address - Fax:
Practice Address - Street 1:525 ROOSVELT AVE
Practice Address - Street 2:SUITE 801 LA TORRE DE PLAZA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-281-0784
Practice Address - Fax:787-764-9482
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2656208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
91855OtherTS
91855OtherTS
C83586Medicare UPIN