Provider Demographics
NPI:1326114232
Name:VANESSA T BENAVIDEZ
Entity Type:Organization
Organization Name:VANESSA T BENAVIDEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BENAVIDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CST, FA
Authorized Official - Phone:719-671-4342
Mailing Address - Street 1:PO BOX 76510
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80970-6510
Mailing Address - Country:US
Mailing Address - Phone:719-638-8844
Mailing Address - Fax:719-638-8115
Practice Address - Street 1:2236 NORWICH AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-1058
Practice Address - Country:US
Practice Address - Phone:719-671-4342
Practice Address - Fax:719-543-4787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO87802246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty