Healthcare Provider Details

I. General information

NPI: 1851947527
Provider Name (Legal Business Name): ROZEE GRACE BENAVIDES DN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2019
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 CARLISLE BLVD NE STE F
ALBUQUERQUE NM
87107-4529
US

IV. Provider business mailing address

4015 CARLISLE BLVD NE STE A
ALBUQUERQUE NM
87107-4529
US

V. Phone/Fax

Practice location:
  • Phone: 505-591-6277
  • Fax: 505-508-0932
Mailing address:
  • Phone: 505-591-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number01051
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: