Provider Demographics
NPI:1548308711
Name:DE BENGSON, CATHY ANN (AP)
Entity type:Individual
Prefix:DR
First Name:CATHY
Middle Name:ANN
Last Name:DE BENGSON
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 HANNAH DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-5882
Mailing Address - Country:US
Mailing Address - Phone:321-453-1059
Mailing Address - Fax:
Practice Address - Street 1:1375 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4470
Practice Address - Country:US
Practice Address - Phone:321-459-5020
Practice Address - Fax:321-459-9490
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1017171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist