Provider Demographics
NPI:1346528247
Name:BENITEZ, CARLOS JOSE (C PED)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JOSE
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PLAZA DR STE 4B
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6049
Mailing Address - Country:US
Mailing Address - Phone:956-205-2981
Mailing Address - Fax:
Practice Address - Street 1:900 PLAZA DR STE 4B
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6049
Practice Address - Country:US
Practice Address - Phone:956-205-2981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCPED3593224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist