Basic Information
| Provider Information | |||||||||
| NPI: | 1023011269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DECENA | ||||||||
| FirstName: | BENIGNO | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3709 N CAMPBELL AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857191563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208382138 | ||||||||
| FaxNumber: | 5206242798 | ||||||||
| Practice Location | |||||||||
| Address1: | 4729 E CAMP LOWELL DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857121256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208383540 | ||||||||
| FaxNumber: | 5203253526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 02/01/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 32303 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 32303 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 2198100 | 01 | AZ | GHI | OTHER | 2Z0331 | 01 | AZ | HEALTH NET | OTHER | 830340 | 05 | AZ | MEDICAID | 2079115 | 01 | AZ | FIRST HEALTH | OTHER | P00084839 | 01 | AZ | RAILROAD MEDICARE | OTHER | 5427615 | 01 | AZ | CCN | OTHER | 7597308 | 01 | AZ | AETNA | OTHER | 886331 | 01 | AZ | USA MANAGED CARE ORGANIZA | OTHER | AZ0743710 | 01 | AZ | BCBS OF ARIZONA | OTHER |