Provider Demographics
NPI:1669193892
Name:BENITEZ DE HERNANDEZ, CANDIDA ROSA
Entity type:Individual
Prefix:
First Name:CANDIDA
Middle Name:ROSA
Last Name:BENITEZ DE HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2384 CHAMPLAIN ST NW APT 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2693
Mailing Address - Country:US
Mailing Address - Phone:202-912-0258
Mailing Address - Fax:
Practice Address - Street 1:2426 19TH ST NW APT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1549
Practice Address - Country:US
Practice Address - Phone:202-234-0229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant