Provider Demographics
NPI:1730645649
Name:BENITEZ, LAIS
Entity Type:Individual
Prefix:
First Name:LAIS
Middle Name:
Last Name:BENITEZ
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 1:5091 NW 7TH ST APT 815
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3473
Mailing Address - Country:US
Mailing Address - Phone:305-877-9876
Mailing Address - Fax:
Practice Address - Street 1:13205 SW 137TH AVE STE 222
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5336
Practice Address - Country:US
Practice Address - Phone:786-250-4423
Practice Address - Fax:305-503-5470
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician