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NPI Code Detail

MEDICARE: MAURO BENAVIDES

MEDICARE: MAURO BENAVIDES
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1336780303
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAURO BENAVIDES
Provider Business Mailing Address
First Line : 20 N DEWITT AVE
Second Line :
City : CLOVIS
State : CA
Zip : 93612-1066
Country : US
Telephone Number : 559-575-8172
Fax Number :
Provider Business Practice Location Address
First Line : 20 N DEWITT AVE
Second Line :
City : CLOVIS
State : CA
Zip : 93612-1066
Country : US
Telephone Number : 559-575-8172
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2019
Last Update Date : 10/01/2019

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Directions to “ MAURO BENAVIDES ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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