Provider Demographics
NPI:1083684146
Name:SIERRA-IRIZARRY, BENIGNO (AUD)
Entity Type:Individual
Prefix:DR
First Name:BENIGNO
Middle Name:
Last Name:SIERRA-IRIZARRY
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9615 FRENCHTREE
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4586
Mailing Address - Country:US
Mailing Address - Phone:210-372-0817
Mailing Address - Fax:
Practice Address - Street 1:2200 BERGQUIST DR
Practice Address - Street 2:AUDIOLOGY AND SPEECH PATHOLOGY ELEMENT
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-4359
Practice Address - Fax:210-292-4310
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50531231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist