Provider Demographics
NPI:1235175894
Name:BENAVIDES, ISABEL (MD)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:BENAVIDES
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 1:27068 LA PAZ RD
Mailing Address - Street 2:STE 299
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3041
Mailing Address - Country:US
Mailing Address - Phone:505-870-3369
Mailing Address - Fax:
Practice Address - Street 1:250 PROSPECT PL
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1943
Practice Address - Country:US
Practice Address - Phone:480-967-6500
Practice Address - Fax:480-967-6540
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0010207P00000X
CAA68376207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ635948Medicaid
NM000G3864Medicaid
AZ635948Medicaid
NM000G3864Medicaid