Male or Other

Didier Mbenza PA-C

Medical Physician Assistant in Lauderdale Lakes, FL(View on Map)

Full Name

Didier Mbenza PA-C

NPI Number

1245587161

NPI Type

Individual Provider

Gender

Male

Enumeration Date

08/09/2012

Specialties

(Taxonomies)

Code

363AM0700X

Primary Taxonomy

Yes

Licenses

State

Florida

License Number

PA9106549

Contact
Information

Purpose

Mailing
Location

Address

3500 N STATE ROAD 7
3500 N STATE ROAD 7

City

Lauderdale Lakes
Lauderdale Lakes

State

FL
FL

Postal Code

33319-5600
33319-5600

Country

US
US

Telephone Number

(954) 766-4233
(954) 766-4233

Identifiers

Identifier

PA9106549

Identifier State

FL

Identifier Issuer

PHYSICIAN ASSISTANT LICENSE

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 08/09/2012

Provider Address

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