Basic Information
| Provider Information | |||||||||
| NPI: | 1740587211 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIAGO BENJUMEA | ||||||||
| FirstName: | JAVIER | ||||||||
| MiddleName: | ANDRES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1910 JOHN RALSTON RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770135531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136739000 | ||||||||
| FaxNumber: | 8558958185 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 JOHN RALSTON RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770135531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136739000 | ||||||||
| FaxNumber: | 8558958185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2011 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | P3143 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME134231 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.