Provider Demographics
NPI:1760688774
Name:BENITEZ CONCEPCION, LOURDES TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:TERESA
Last Name:BENITEZ CONCEPCION
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:CALLE 8 BLOQUE 31 CASA #2
Mailing Address - Street 2:URB. VILLA CAROLINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5434
Mailing Address - Country:US
Mailing Address - Phone:787-210-3526
Mailing Address - Fax:
Practice Address - Street 1:AVE. LAUREL, SANTA JUANITA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-787-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26254-R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine