Provider Demographics
NPI:1477442234
Name:BENITEZ LOZANO, GRETER
Entity type:Individual
Prefix:
First Name:GRETER
Middle Name:
Last Name:BENITEZ LOZANO
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 1:5020 PALM RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-3740
Mailing Address - Country:US
Mailing Address - Phone:813-900-1667
Mailing Address - Fax:813-900-1667
Practice Address - Street 1:5020 PALM RIVER RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-3740
Practice Address - Country:US
Practice Address - Phone:813-900-1667
Practice Address - Fax:813-900-1667
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-388495106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician