Healthcare Provider Details

I. General information

NPI: 1871104232
Provider Name (Legal Business Name): ABEL CAMINO BENECH FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11980 KIRBY DR STE 102
HOUSTON TX
77045-4860
US

IV. Provider business mailing address

11980 KIRBY DR STE 102
HOUSTON TX
77045-4860
US

V. Phone/Fax

Practice location:
  • Phone: 713-848-0958
  • Fax: 713-433-3709
Mailing address:
  • Phone: 713-848-0985
  • Fax: 713-433-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1008693
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: