MEDICARE: NADIA BENAVIDEZ

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
1	246Z00000X	Other Specialist/Technologist	HAD2044	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1720135783	OTHER		NPI

General Provider Information

NPI Number	:	1518582121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADIA BENAVIDEZ

Provider Business Mailing Address
First Line	:	1155 S POWER RD STE 109
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-3716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 S POWER RD STE 109
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-3716
Country	:	US
Telephone Number	:	480-807-6335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	06/09/2020

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Directions to “ NADIA BENAVIDEZ ” Practice Location

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