Provider Demographics
NPI:1578779674
Name:BENAVIDES, ROBERT J (AFCP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:BENAVIDES
Suffix:
Gender:M
Credentials:AFCP
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:JOSEPH
Other - Last Name:BENAVIDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AFCP
Mailing Address - Street 1:8502 CHIMNEYHILL ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2019
Mailing Address - Country:US
Mailing Address - Phone:210-522-9732
Mailing Address - Fax:
Practice Address - Street 1:8502 CHIMNEYHILL ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-2019
Practice Address - Country:US
Practice Address - Phone:210-522-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119321171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor