Provider Demographics
NPI:1023344843
Name:BENABE, CARMEN H (OD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:H
Last Name:BENABE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194483
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4483
Mailing Address - Country:US
Mailing Address - Phone:787-637-1464
Mailing Address - Fax:
Practice Address - Street 1:201 AVE DE DIEGO STE 40
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5828
Practice Address - Country:US
Practice Address - Phone:787-637-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR624152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist