Provider Demographics
NPI:1881419570
Name:BENAVIDES, ESEQUIEL JR
Entity type:Individual
Prefix:
First Name:ESEQUIEL
Middle Name:
Last Name:BENAVIDES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 UNION ST APT 607
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1912
Mailing Address - Country:US
Mailing Address - Phone:253-224-5948
Mailing Address - Fax:
Practice Address - Street 1:2133 3RD AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2385
Practice Address - Country:US
Practice Address - Phone:206-223-3644
Practice Address - Fax:206-223-1482
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker