Provider Demographics
NPI:1093723876
Name:BENAVIDES, RICARDO M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:M
Last Name:BENAVIDES
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:135 BUNTON CREEK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5701
Mailing Address - Country:US
Mailing Address - Phone:512-268-2091
Mailing Address - Fax:512-268-2190
Practice Address - Street 1:135 BUNTON CREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5701
Practice Address - Country:US
Practice Address - Phone:512-268-2091
Practice Address - Fax:512-268-2190
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA04986363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant