Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME119272 | FL |
NPI | 1003100066 |
---|---|
Provider Name | Rosabel Maria Bencomo |
First Address | Miami, FL 33155-3756 |
Second Address | Miami, FL 33155-3756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2011 |
Last Update Date | 12/01/2020 |