Healthcare Provider Details

I. General information

NPI: 1104123488
Provider Name (Legal Business Name): BENETTE ADAMS NOT APPLICABLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 07/21/2022
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 NW 53RD ST STE 337
MIAMI FL
33166-4791
US

IV. Provider business mailing address

7950 NW 53RD ST STE 337
MIAMI FL
33166-4791
US

V. Phone/Fax

Practice location:
  • Phone: 954-627-4601
  • Fax: 305-691-5672
Mailing address:
  • Phone: 786-709-3410
  • Fax: 305-691-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number0290
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: