Provider Demographics
NPI:1497270953
Name:ESTEVEZ, BIENVENIDO DE JESUS I (BS)
Entity Type:Individual
Prefix:MR
First Name:BIENVENIDO
Middle Name:DE JESUS
Last Name:ESTEVEZ
Suffix:I
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 TENNEY ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2423
Mailing Address - Country:US
Mailing Address - Phone:978-609-6076
Mailing Address - Fax:
Practice Address - Street 1:12 METHUEN ST FL 3
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1700
Practice Address - Country:US
Practice Address - Phone:978-683-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management