Provider Demographics
NPI:1740558444
Name:BENAVIDES, NORA LIGIA (DO)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:LIGIA
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:LIGIA
Other - Last Name:BENAVIDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5115 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1042
Mailing Address - Country:US
Mailing Address - Phone:718-734-3020
Mailing Address - Fax:718-734-3027
Practice Address - Street 1:5115 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1042
Practice Address - Country:US
Practice Address - Phone:718-734-3020
Practice Address - Fax:718-734-3027
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program