Provider Demographics
NPI:1083810170
Name:BENELLI, GEORGE ROBERT (RT, RPA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ROBERT
Last Name:BENELLI
Suffix:
Gender:M
Credentials:RT, RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 SW 165TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3264
Mailing Address - Country:US
Mailing Address - Phone:786-427-4287
Mailing Address - Fax:305-325-4362
Practice Address - Street 1:1400 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1003
Practice Address - Country:US
Practice Address - Phone:305-325-5916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL576462471V0106X
FL243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular-Interventional Technology
No243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant