Healthcare Provider Details

I. General information

NPI: 1811197346
Provider Name (Legal Business Name): ATTLEE BECENTI BENALLY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAGEBRUSH RD. ISLETA PUEBLO DIABETIC CLINIC
ISLETA NM
87022
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 925-642-0578
  • Fax:
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number321
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE 4732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: