Provider Demographics
NPI:1033378047
Name:BENTE, JEANNIE CANALITO (LMT)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:CANALITO
Last Name:BENTE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16956 HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-2103
Mailing Address - Country:US
Mailing Address - Phone:281-338-7338
Mailing Address - Fax:281-338-7338
Practice Address - Street 1:16956 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-2103
Practice Address - Country:US
Practice Address - Phone:281-338-7338
Practice Address - Fax:281-338-7338
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT010576174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist