Healthcare Provider Details

I. General information

NPI: 1477415867
Provider Name (Legal Business Name): INES B BENAVIDES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3057 KINGS RIDGE BLVD UNIT B
BOULDER CO
80301-5440
US

IV. Provider business mailing address

3057 KINGS RIDGE BLVD UNIT B
BOULDER CO
80301-5440
US

V. Phone/Fax

Practice location:
  • Phone: 904-514-2624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: