Provider Demographics
NPI:1851947527
Name:BENAVIDES, ROZEE GRACE (DN)
Entity Type:Individual
Prefix:DR
First Name:ROZEE
Middle Name:GRACE
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 CARLISLE BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4529
Mailing Address - Country:US
Mailing Address - Phone:505-591-6277
Mailing Address - Fax:
Practice Address - Street 1:4015 CARLISLE BLVD NE STE F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4529
Practice Address - Country:US
Practice Address - Phone:505-591-6277
Practice Address - Fax:505-508-0932
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-17
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM01051172P00000X, 172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath