Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | ME50234 | FL |
N | 2080A0000X | Adolescent Medicine | ME50234 | FL |
NPI | 1689638157 |
---|---|
Provider Name | Dr. Jose A. Bengochea |
First Address | Coral Gables, FL 33134-6000 |
Second Address | Coral Gables, FL 33134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 12/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013631900 | (05) | FL |
F57969 | (02) |