Provider Demographics
NPI:1356384606
Name:BENITO, JORGE (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:BENITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10798 SW 43RD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4857
Mailing Address - Country:US
Mailing Address - Phone:786-718-7073
Mailing Address - Fax:305-709-6058
Practice Address - Street 1:7000 SW 62ND AVE STE 600
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4728
Practice Address - Country:US
Practice Address - Phone:786-718-7073
Practice Address - Fax:305-709-6058
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 626602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371324500Medicaid
FL17896CMedicare PIN
FL371324500Medicaid