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NPI Code Detail

MEDICARE: VANESSA BENAVIDEZ CST, FA

MEDICARE: VANESSA BENAVIDEZ CST, FA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246ZS0410XSurgical Technologist87802CO

General Provider Information

NPI Number : 1053487876
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA BENAVIDEZ CST, FA
Provider Business Mailing Address
First Line : 1302 CHINOOK LN
Second Line :
City : PUEBLO
State : CO
Zip : 81001-1851
Country : US
Telephone Number : 719-545-2746
Fax Number : 719-545-4100
Provider Business Practice Location Address
First Line : 1302 CHINOOK LN
Second Line :
City : PUEBLO
State : CO
Zip : 81001-1851
Country : US
Telephone Number : 719-545-2746
Fax Number : 719-545-4100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2006
Last Update Date : 08/04/2015

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Directions to “ VANESSA BENAVIDEZ CST, FA” Practice Location

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