Healthcare Provider Details

I. General information

NPI: 1609680388
Provider Name (Legal Business Name): GABRIELLE ELIZABETH BENITEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RIO GRANDE BLVD NW STE H160
ALBUQUERQUE NM
87104-2063
US

IV. Provider business mailing address

9400 TOUCAN PL NW
ALBUQUERQUE NM
87114-3612
US

V. Phone/Fax

Practice location:
  • Phone: 505-278-0807
  • Fax:
Mailing address:
  • Phone: 505-314-6572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberINTERN
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: