Healthcare Provider Details

I. General information

NPI: 1295664761
Provider Name (Legal Business Name): BENOMIND VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 NW 190TH ST
MIAMI GARDENS FL
33169-3904
US

IV. Provider business mailing address

365 NW 190TH ST
MIAMI GARDENS FL
33169-3904
US

V. Phone/Fax

Practice location:
  • Phone: 786-395-5615
  • Fax:
Mailing address:
  • Phone: 786-395-5615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARLOS GOMEZ
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 786-395-5615