Provider Demographics
NPI:1245919034
Name:FIGUEROA BENITEZ, IRALIS
Entity type:Individual
Prefix:
First Name:IRALIS
Middle Name:
Last Name:FIGUEROA BENITEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9942 NW 123RD ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5900
Mailing Address - Country:US
Mailing Address - Phone:786-299-6832
Mailing Address - Fax:
Practice Address - Street 1:9942 NW 123RD ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5900
Practice Address - Country:US
Practice Address - Phone:786-299-6832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-273406106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty