Provider Demographics
NPI:1316987597
Name:BENAVIDES, VALENTE ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:VALENTE
Middle Name:ANTONIO
Last Name:BENAVIDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N ESPLANADE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-4723
Mailing Address - Country:US
Mailing Address - Phone:361-275-9754
Mailing Address - Fax:
Practice Address - Street 1:2500 N ESPLANADE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-4723
Practice Address - Country:US
Practice Address - Phone:361-275-9754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7887208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034942501Medicaid
TX034942502Medicaid
TX00N08LMedicare Oscar/Certification
F82526Medicare UPIN
TX034942502Medicaid