Provider Demographics
NPI:1083659387
Name:BENITEZ, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 NW 138TH TER
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2090
Mailing Address - Country:US
Mailing Address - Phone:352-332-2345
Mailing Address - Fax:352-332-2394
Practice Address - Street 1:215 NW 138TH TER
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-2090
Practice Address - Country:US
Practice Address - Phone:352-332-2345
Practice Address - Fax:352-332-2394
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75288174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256212000Medicaid
FL256212000Medicaid
FLH80962Medicare UPIN