Provider Information for 1003442385
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VANESSA NICOLE BENAVIDES
Sex: Female
NPI: 1003442385
Last Updated: 2020-03-18
Certification Date: 2020-03-18
Certification Date: 2020-03-18
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1003442385 | ||||||||
| Enumeration Date | 2020-03-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 601 W WEBB ST CRYSTAL CITY, TX 78839-3825 United States Phone: 830-374-6968 | Fax: | ||||||||
| Primary Practice Address | 308 S CESAR CHAVEZ AVE CRYSTAL CITY, TX 78839-4200 United States Phone: 830-374-2301 | Fax: | ||||||||
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