Healthcare Provider Details

I. General information

NPI: 1225180946
Provider Name (Legal Business Name): OSCAR BENAVIDES MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W VILLAGE BLVD STE 11
LAREDO TX
78041-2227
US

IV. Provider business mailing address

209 W VILLAGE BLVD STE 11
LAREDO TX
78041-2227
US

V. Phone/Fax

Practice location:
  • Phone: 956-725-5210
  • Fax: 956-717-1708
Mailing address:
  • Phone: 956-725-5210
  • Fax: 956-717-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH9039
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0104598
License Number StateTX

VIII. Authorized Official

Name: MRS. FELICITAS BENAVIDES
Title or Position: MANAGER
Credential: RN
Phone: 956-725-5210