Provider Demographics
NPI:1114145349
Name:PEREZ BENITEZ, CARLOS ISRAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ISRAEL
Last Name:PEREZ BENITEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W FLAGLER ST
Mailing Address - Street 2:STE 310
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2099
Mailing Address - Country:US
Mailing Address - Phone:786-467-7006
Mailing Address - Fax:786-999-0971
Practice Address - Street 1:1701 W FLAGLER ST STE 310
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2099
Practice Address - Country:US
Practice Address - Phone:786-467-7006
Practice Address - Fax:786-999-0971
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical