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General NPI Number Information
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NPI Number | 1427875699
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Entity Type | Individual
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Provider Name | BENJAMIN ONTIVEROS PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 09/20/2024
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 5001 N PIEDRAS ST
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City | EL PASO
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State | TX
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Zip | 79930-4210
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Country | US
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Telephone | 915-256-4787
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1312
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City | CANUTILLO
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State | TX
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Zip | 79835-1312
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1175447
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License Number State | TX
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