Provider Demographics
NPI:1033736533
Name:BENAVIDES CHAPA, GRECIA MARIEL (NP)
Entity Type:Individual
Prefix:
First Name:GRECIA
Middle Name:MARIEL
Last Name:BENAVIDES CHAPA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-2276
Mailing Address - Country:US
Mailing Address - Phone:956-787-8915
Mailing Address - Fax:956-787-2021
Practice Address - Street 1:611 N BRYAN RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6285
Practice Address - Country:US
Practice Address - Phone:956-580-3303
Practice Address - Fax:956-580-1505
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34302363LF0000X
TXAP146039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily