Provider Demographics
NPI:1194009092
Name:BENAZET PAIN MANAGEMENT AND REHAB CENTER INC
Entity Type:Organization
Organization Name:BENAZET PAIN MANAGEMENT AND REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TULIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENAZAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-456-1829
Mailing Address - Street 1:7235 CORAL WAY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1466
Mailing Address - Country:US
Mailing Address - Phone:305-456-1829
Mailing Address - Fax:305-456-9971
Practice Address - Street 1:7235 CORAL WAY
Practice Address - Street 2:SUITE 207
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1466
Practice Address - Country:US
Practice Address - Phone:305-456-1829
Practice Address - Fax:305-456-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81181208D00000X
FLME81033208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC7849OtherAHCA