Provider Demographics
NPI:1669706297
Name:BENITEZ DOMINGUEZ, OSCAR (CBHCMS, APRN)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:BENITEZ DOMINGUEZ
Suffix:
Gender:M
Credentials:CBHCMS, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3117
Mailing Address - Country:US
Mailing Address - Phone:786-370-8755
Mailing Address - Fax:
Practice Address - Street 1:2750 W 68TH ST # 127-128
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5446
Practice Address - Country:US
Practice Address - Phone:305-558-0765
Practice Address - Fax:305-558-0768
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLAPRN11025243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No104100000XBehavioral Health & Social Service ProvidersSocial Worker