Provider Demographics
NPI:1801241369
Name:BENAVIDES, OVIDIO II (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:OVIDIO
Middle Name:
Last Name:BENAVIDES
Suffix:II
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:OBIE
Other - Middle Name:
Other - Last Name:BENAVIDES
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8322 BEECHNUT ST APT A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-6886
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6100 MAIN ST # MS 552
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1827
Practice Address - Country:US
Practice Address - Phone:559-904-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT56292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer