Healthcare Provider Details

I. General information

NPI: 1699931782
Provider Name (Legal Business Name): OMAR BENITEZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 SW 1ST ST SUITE 107
MIAMI FL
33135-1694
US

IV. Provider business mailing address

2141 SW 1ST ST SUITE 107
MIAMI FL
33135-1694
US

V. Phone/Fax

Practice location:
  • Phone: 305-591-0027
  • Fax: 305-591-4284
Mailing address:
  • Phone: 305-591-0027
  • Fax: 305-591-4284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberHCC6978
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: OMAR BENITEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-591-0027