Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 21150 | PR |
NPI | 1003343773 |
---|---|
Provider Name | Dr. Josue Alexis Benabe Carlo |
First Address | Las Piedras, PR 00771 |
Second Address | Las Piedras, PR 00771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2017 |
Last Update Date | 18/03/2019 |