Provider Demographics
NPI:1518573146
Name:BENCOMO, DUNIA
Entity Type:Individual
Prefix:
First Name:DUNIA
Middle Name:
Last Name:BENCOMO
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 1:3339 SW 139TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6764
Mailing Address - Country:US
Mailing Address - Phone:786-366-7045
Mailing Address - Fax:
Practice Address - Street 1:3750 W 16TH AVE STE 218
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4648
Practice Address - Country:US
Practice Address - Phone:786-366-7045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty