Healthcare Provider Details

I. General information

NPI: 1679257646
Provider Name (Legal Business Name): ELISE BENITEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 10/10/2024
Certification Date: 10/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7875 NW 12TH ST SUITE 110
DORAL FL
33126
US

IV. Provider business mailing address

1408 OBISPO AVE
CORAL GABLES FL
33134-3514
US

V. Phone/Fax

Practice location:
  • Phone: 786-269-3500
  • Fax:
Mailing address:
  • Phone: 305-469-9659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: