Healthcare Provider Details

I. General information

NPI: 1356174080
Provider Name (Legal Business Name): CYA BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 CUBA AVE STE 5
ALAMOGORDO NM
88310-5646
US

IV. Provider business mailing address

2200 1ST ST APT 301
ALAMOGORDO NM
88310-3404
US

V. Phone/Fax

Practice location:
  • Phone: 575-489-4616
  • Fax:
Mailing address:
  • Phone: 915-201-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: