Provider Demographics
NPI:1639124902
Name:BENAZET, TULIA ROSARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:TULIA
Middle Name:ROSARIO
Last Name:BENAZET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TULIA
Other - Middle Name:ROSARIO
Other - Last Name:VIDAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:22 NW 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1913
Mailing Address - Country:US
Mailing Address - Phone:305-222-8173
Mailing Address - Fax:
Practice Address - Street 1:7235 CORAL WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1466
Practice Address - Country:US
Practice Address - Phone:305-260-9602
Practice Address - Fax:305-260-9607
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81181207W00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259867100Medicaid
FL259867100Medicaid
FLH28763Medicare UPIN