Provider Demographics
NPI:1841217494
Name:JORGE BENITO MD PA
Entity Type:Organization
Organization Name:JORGE BENITO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNEROFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-294-3745
Mailing Address - Street 1:PO BOX 430773
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-0773
Mailing Address - Country:US
Mailing Address - Phone:786-718-7073
Mailing Address - Fax:305-709-6058
Practice Address - Street 1:13240 SW 82ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-6602
Practice Address - Country:US
Practice Address - Phone:786-718-7073
Practice Address - Fax:305-709-6058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME626602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC181Medicare PIN