MEDICARE: DAILY BENITEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-23-297075	FL

General Provider Information

NPI Number	:	1164294997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAILY BENITEZ

Provider Business Mailing Address
First Line	:	12144 66TH ST N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-2042
Country	:	US
Telephone Number	:	561-506-2789
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 S DIXIE HWY BAY 4&5
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-4404
Country	:	US
Telephone Number	:	786-281-2421
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2023
Last Update Date	:	10/25/2023

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