Provider Demographics
NPI:1992380786
Name:BENITEZ LUETH, JORGE F
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:F
Last Name:BENITEZ LUETH
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 1:26464 SW 124TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7913
Mailing Address - Country:US
Mailing Address - Phone:786-314-4107
Mailing Address - Fax:
Practice Address - Street 1:26464 SW 124TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-7913
Practice Address - Country:US
Practice Address - Phone:786-314-4107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty