Provider Demographics
NPI:1225866957
Name:BENAVIDES, VICTOR (MT)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:BENAVIDES
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 CITRUS ISLE LOOP
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-7705
Mailing Address - Country:US
Mailing Address - Phone:786-679-5638
Mailing Address - Fax:
Practice Address - Street 1:402 CITRUS ISLE LOOP
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7705
Practice Address - Country:US
Practice Address - Phone:786-679-5638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL79642225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist