Provider Demographics
NPI:1104625144
Name:BENAVIDES, MARQUI LYNELLE (RDN, LD)
Entity type:Individual
Prefix:
First Name:MARQUI
Middle Name:LYNELLE
Last Name:BENAVIDES
Suffix:
Gender:
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 17TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-5824
Mailing Address - Country:US
Mailing Address - Phone:512-773-4452
Mailing Address - Fax:
Practice Address - Street 1:4206 17TH ST APT 3
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-5824
Practice Address - Country:US
Practice Address - Phone:512-773-4452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87720133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered