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NPI Code Detail

MEDICARE: MR. RICARDO M BENAVIDES PA-C

MEDICARE:  MR. RICARDO M BENAVIDES  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363A00000XPhysician AssistantPA04986TX

General Provider Information

NPI Number : 1093723876
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICARDO M BENAVIDES PA-C
Provider Business Mailing Address
First Line : 135 BUNTON CREEK RD STE 102
Second Line :
City : KYLE
State : TX
Zip : 78640-5701
Country : US
Telephone Number : 512-268-2091
Fax Number : 512-268-2190
Provider Business Practice Location Address
First Line : 135 BUNTON CREEK RD STE 102
Second Line :
City : KYLE
State : TX
Zip : 78640-5701
Country : US
Telephone Number : 512-268-2091
Fax Number : 512-268-2190
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 03/20/2021

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Directions to “ MR. RICARDO M BENAVIDES PA-C” Practice Location

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