Healthcare Provider Details

I. General information

NPI: 1962094060
Provider Name (Legal Business Name): YANIA BENECH JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 BIRD RD
MIAMI FL
33155-4825
US

IV. Provider business mailing address

29 SANTILLANE AVE APT 6
CORAL GABLES FL
33134-3130
US

V. Phone/Fax

Practice location:
  • Phone: 786-216-7382
  • Fax: 954-206-0906
Mailing address:
  • Phone: 713-409-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: