Healthcare Provider Details

I. General information

NPI: 1467706101
Provider Name (Legal Business Name): MAYDEL NORIS BENITEZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2943 KENTUCKY ST
WEST PALM BEACH FL
33406-4244
US

IV. Provider business mailing address

2943 KENTUCKY ST
WEST PALM BEACH FL
33406-4244
US

V. Phone/Fax

Practice location:
  • Phone: 561-215-2649
  • Fax:
Mailing address:
  • Phone: 561-215-2649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA65097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: