Provider Demographics
NPI:1033486170
Name:BENAVIDEZ, ANDRES ABRAHAM
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:ABRAHAM
Last Name:BENAVIDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13780 SW 160TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1945
Mailing Address - Country:US
Mailing Address - Phone:786-991-5889
Mailing Address - Fax:
Practice Address - Street 1:13780 SW 160TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1945
Practice Address - Country:US
Practice Address - Phone:786-991-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician