Provider Demographics
NPI:1770590978
Name:BENSON, ROBYN (DOM)
Entity type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PIUTE RD.
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-986-1089
Mailing Address - Fax:505-986-0194
Practice Address - Street 1:2905 RODEO PARK DR E BLDG 3
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6313
Practice Address - Country:US
Practice Address - Phone:505-986-1089
Practice Address - Fax:505-986-0194
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM274RX2171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist