Provider Demographics
NPI:1578335089
Name:RODRIGUEZ BENITEZ, CARLOS JOSE
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JOSE
Last Name:RODRIGUEZ BENITEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6461 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4134
Mailing Address - Country:US
Mailing Address - Phone:954-297-4474
Mailing Address - Fax:
Practice Address - Street 1:6461 THOMAS ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-4134
Practice Address - Country:US
Practice Address - Phone:954-297-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT23300510106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician