Provider Demographics
NPI:1881210367
Name:PENA-BENAVIDES, KASSANDRA NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:KASSANDRA
Middle Name:NICOLE
Last Name:PENA-BENAVIDES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9114 MCPHERSON RD APT 4705
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6652
Mailing Address - Country:US
Mailing Address - Phone:956-763-8133
Mailing Address - Fax:
Practice Address - Street 1:5702 MCPHERSON RD STE 21
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6884
Practice Address - Country:US
Practice Address - Phone:956-791-5967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9948TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist