Provider Demographics
NPI:1790271831
Name:BENAVIDEZ, JAZMINE GABRIELLE (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JAZMINE
Middle Name:GABRIELLE
Last Name:BENAVIDEZ
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3669 MAYA CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-5100
Mailing Address - Country:US
Mailing Address - Phone:575-574-2811
Mailing Address - Fax:
Practice Address - Street 1:1955 N VALLEY DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-5154
Practice Address - Country:US
Practice Address - Phone:575-527-9415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer