Provider Demographics
NPI:1962194118
Name:VICTORI-BENCOMO, ODENNYS MARCOS
Entity type:Individual
Prefix:
First Name:ODENNYS
Middle Name:MARCOS
Last Name:VICTORI-BENCOMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 SW 105TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7937
Mailing Address - Country:US
Mailing Address - Phone:786-818-0293
Mailing Address - Fax:
Practice Address - Street 1:2021 SW 105TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7937
Practice Address - Country:US
Practice Address - Phone:786-818-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-272957106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician