Individual
MR. FEDERICO BENGOA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3501 JOHNSON ST, HOLLYWOOD, FL 33021-5421
(954) 387-2000
(954) 437-6628
Mailing address
500 N HIATUS RD STE 200, PEMBROKE PINES, FL 33026-5213
(954) 437-4800
(954) 437-6628
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
ME88345
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558364786
NPI
FL
05
—
267631100
—
FL
01
—
290610
AVMED
FL
01
—
81202
BLUE CROSS BLUE SHIELD
FL
01
—
P00058187
RAILROAD MEDICARE
FL
Enumeration date
05/23/2005
Last updated
03/07/2023
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