Provider Demographics
NPI:1467595405
Name:CARRERA LEAL, BENITO (MD)
Entity Type:Individual
Prefix:DR
First Name:BENITO
Middle Name:
Last Name:CARRERA LEAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 W HIGHWAY 290
Mailing Address - Street 2:SUITE 502-191
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8400
Mailing Address - Country:US
Mailing Address - Phone:512-296-2160
Mailing Address - Fax:512-296-2160
Practice Address - Street 1:225 E SONTERRA BLVD
Practice Address - Street 2:SUITE #201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3992
Practice Address - Country:US
Practice Address - Phone:512-797-1818
Practice Address - Fax:210-545-3455
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6819174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100540704Medicaid
TX612175Medicare ID - Type Unspecified
TXG81402Medicare UPIN