Provider Demographics
NPI:1316570617
Name:GONZALEZ BENAVIDES, JOSE LEONARDO (SA-C)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LEONARDO
Last Name:GONZALEZ BENAVIDES
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 205 LOOP APT 284
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-4019
Mailing Address - Country:US
Mailing Address - Phone:254-239-8945
Mailing Address - Fax:
Practice Address - Street 1:5433 205 LOOP APT 284
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-4019
Practice Address - Country:US
Practice Address - Phone:254-239-8945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20-132246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant