Provider Demographics
NPI:1992013031
Name:BENVENUTO, LOUISE MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:MARY
Last Name:BENVENUTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LOUISE
Other - Middle Name:MARY
Other - Last Name:TUBIO-CID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:128 VIZCAYA ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1735
Mailing Address - Country:US
Mailing Address - Phone:561-214-1462
Mailing Address - Fax:561-626-0446
Practice Address - Street 1:128 VIZCAYA ESTATES DR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-1735
Practice Address - Country:US
Practice Address - Phone:561-214-1462
Practice Address - Fax:561-626-0446
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94259207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology