Provider Demographics
NPI:1669580452
Name:MENENDEZ RUIZ, BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:MENENDEZ RUIZ
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:COND THE TOWERS 10 CALLE LAS ROSAS
Mailing Address - Street 2:APT 1706
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7042
Mailing Address - Country:US
Mailing Address - Phone:787-649-7693
Mailing Address - Fax:787-883-4434
Practice Address - Street 1:COND THE TOWERS 10 CALLE LAS ROSAS
Practice Address - Street 2:APT 1706
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7042
Practice Address - Country:US
Practice Address - Phone:787-649-7693
Practice Address - Fax:787-883-4434
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14541208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14541OtherSTATE LICENSE
PRDM147025-2OtherASSMCA
PR21412Medicare ID - Type Unspecified
PRBM8051992OtherDEA
PRH80727Medicare UPIN