Provider Demographics
NPI:1043723935
Name:BENEDICO OSUNA, MIGDELYS CORALIA
Entity Type:Individual
Prefix:
First Name:MIGDELYS
Middle Name:CORALIA
Last Name:BENEDICO OSUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9433 SW 174TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5614
Mailing Address - Country:US
Mailing Address - Phone:918-954-6697
Mailing Address - Fax:
Practice Address - Street 1:9433 SW 174TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5614
Practice Address - Country:US
Practice Address - Phone:786-445-1738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician