MEDICARE: CLAUDIA BENAVIDES RENDON LVN

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
1	164X00000X	Licensed Vocational Nurse	198789	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	198789	OTHER	TX	LVN LICENSE

General Provider Information

NPI Number	:	1649430265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAUDIA BENAVIDES RENDON LVN

Provider Business Mailing Address
First Line	:	819 WATER ST
Second Line	:	300
City	:	KERRVILLE
State	:	TX
Zip	:	78028-5333
Country	:	US
Telephone Number	:	830-258-5430
Fax Number	:	830-792-5771

Provider Business Practice Location Address
First Line	:	324 CRYSTAL CITY HWY
Second Line	:
City	:	UVALDE
State	:	TX
Zip	:	78801-6124
Country	:	US
Telephone Number	:	830-278-1243
Fax Number	:	830-278-1243

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/17/2008

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