Provider Demographics
NPI:1184871238
Name:BENITEZ, GLORIA (OD)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:14732 SW 43RD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4354
Mailing Address - Country:US
Mailing Address - Phone:305-984-4605
Mailing Address - Fax:
Practice Address - Street 1:11850 SHERRY LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4833
Practice Address - Country:US
Practice Address - Phone:727-344-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4296152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist