Basic Information
| Provider Information | |||||||||
| NPI: | 1013955988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENITEZ | ||||||||
| FirstName: | NORMA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3191 CORAL WAY | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331453213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054616060 | ||||||||
| FaxNumber: | 3054615911 | ||||||||
| Practice Location | |||||||||
| Address1: | 6221 N FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333081903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544911686 | ||||||||
| FaxNumber: | 3054615911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME0054073 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | ME0054073 | 01 | FL | MEDICAL LICENSE | OTHER | BB1891591 | 01 | FL | DEA | OTHER |