Provider Demographics
NPI:1275242695
Name:SAROL BENAVIDES, TALIA
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:SAROL BENAVIDES
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 1:1490 W 29TH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5590
Mailing Address - Country:US
Mailing Address - Phone:772-226-9846
Mailing Address - Fax:
Practice Address - Street 1:1490 W 29TH ST APT 10
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5590
Practice Address - Country:US
Practice Address - Phone:772-226-9846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician