Provider Demographics
NPI:1285682302
Name:BENITEZ, ANIA (MD)
Entity Type:Individual
Prefix:
First Name:ANIA
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 1:3750 W 16TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4654
Mailing Address - Country:US
Mailing Address - Phone:305-558-3220
Mailing Address - Fax:305-558-3136
Practice Address - Street 1:3750 W 16TH AVE
Practice Address - Street 2:SUITE#110
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4654
Practice Address - Country:US
Practice Address - Phone:305-558-3220
Practice Address - Fax:305-558-3136
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90842208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270081600Medicaid
FL270081600Medicaid
FLU3343DMedicare PIN