Healthcare Provider Details

I. General information

NPI: 1003894494
Provider Name (Legal Business Name): OSCAR J BENAVIDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1193 W 49TH ST
HIALEAH FL
33012-3337
US

IV. Provider business mailing address

900 S PINE ISLAND RD SUITE 800
PLANTATION FL
33324-3920
US

V. Phone/Fax

Practice location:
  • Phone: 305-777-9190
  • Fax: 305-779-0720
Mailing address:
  • Phone: 305-777-9190
  • Fax: 305-779-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME99106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: