Provider Demographics
NPI:1821282021
Name:BENITEZ BAJANDAS, GABRIEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:A
Last Name:BENITEZ BAJANDAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GABRIEL
Other - Middle Name:A
Other - Last Name:BENITEZ BAJANDAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0519
Mailing Address - Country:US
Mailing Address - Phone:787-697-1171
Mailing Address - Fax:787-850-5005
Practice Address - Street 1:125 CALLE FONT MARTELO E
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3955
Practice Address - Country:US
Practice Address - Phone:787-852-6825
Practice Address - Fax:787-421-7613
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18542207W00000X, 207W00000X
WV24464207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology