Provider Demographics
NPI:1982120523
Name:O BENITEZ, OSCAR (SA-C)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:O BENITEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 SANDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2933
Mailing Address - Country:US
Mailing Address - Phone:214-437-3467
Mailing Address - Fax:
Practice Address - Street 1:233 SANDLEWOOD LN
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2933
Practice Address - Country:US
Practice Address - Phone:214-437-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17-440246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant