Provider Demographics
NPI:1891992780
Name:LOPEZ-BENITEZ, LUIS J (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:J
Last Name:LOPEZ-BENITEZ
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 1:6850 N DURANGO DRIVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149
Mailing Address - Country:US
Mailing Address - Phone:702-476-1100
Mailing Address - Fax:702-476-1101
Practice Address - Street 1:6850 N DURANGO DRIVE
Practice Address - Street 2:SUITE 420
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149
Practice Address - Country:US
Practice Address - Phone:702-476-1100
Practice Address - Fax:702-476-1101
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12325207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1891992780Medicaid
NV1891992780Medicare PIN
NV1891992780Medicaid