Individual
DIDIER MBENZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3500 N STATE ROAD 7, SUITE 211, LAUDERDALE LAKES, FL 33319-5600
(954) 766-4233
(954) 306-2056
Mailing address
3500 N STATE ROAD 7, SUITE 211, LAUDERDALE LAKES, FL 33319-5600
(954) 766-4233
(954) 306-2056
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9106549
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9106549
PHYSICIAN ASSISTANT LICENSE
FL
Enumeration date
08/09/2012
Last updated
08/09/2012
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