Provider Demographics
NPI:1851529432
Name:NUNEZ, BENJASON RODRIGO (DO)
Entity Type:Individual
Prefix:DR
First Name:BENJASON
Middle Name:RODRIGO
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JASON
Other - Middle Name:RODRIGO
Other - Last Name:NUNEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:501 N LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1114
Mailing Address - Country:US
Mailing Address - Phone:610-284-8100
Mailing Address - Fax:
Practice Address - Street 1:501 N LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1114
Practice Address - Country:US
Practice Address - Phone:610-284-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015682207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine