Provider Demographics
NPI:1689481418
Name:NIEBLA BENAVIDES, MAILEN
Entity type:Individual
Prefix:
First Name:MAILEN
Middle Name:
Last Name:NIEBLA BENAVIDES
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 1:8964 W FLAGLER ST APT 219
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3904
Mailing Address - Country:US
Mailing Address - Phone:786-538-1050
Mailing Address - Fax:
Practice Address - Street 1:8964 W FLAGLER ST APT 219
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3904
Practice Address - Country:US
Practice Address - Phone:786-538-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-386894106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician