Provider Demographics
NPI:1043349756
Name:BENNY, ROSE SANTIAGO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:SANTIAGO
Last Name:BENNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20303 S UNIVERSITY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3662
Mailing Address - Country:US
Mailing Address - Phone:281-208-9503
Mailing Address - Fax:281-208-9504
Practice Address - Street 1:20303 S UNIVERSITY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3662
Practice Address - Country:US
Practice Address - Phone:281-208-9503
Practice Address - Fax:281-208-9504
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5050208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183880702Medicaid