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General NPI Number Information
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NPI Number | 1821618752
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Entity Type | Individual
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Provider Name | JOEL BENAVIDES
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Gender | Male
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 21201 MORTON RD
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City | KATY
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State | TX
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Zip | 77449-1966
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Country | US
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Telephone | 281-599-8888
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Fax | 281-578-2763
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Provider Business Mailing Address
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Address Line | 9723 RED RUGOSSA DR
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City | HOUSTON
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State | TX
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Zip | 77095-5085
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Country | US
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Telephone | 281-782-2527
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP145141
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License Number State | TX
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