Provider Demographics
NPI:1336221662
Name:BENAVIDES, MELISSA ANN (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:333 N SANTA ROSA ST
Mailing Address - Street 2:CENTER FOR CHILDREN & FAMILIES, 4TH FLOOR, CLINIC A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3108
Mailing Address - Country:US
Mailing Address - Phone:210-704-8810
Mailing Address - Fax:210-704-4136
Practice Address - Street 1:333 N SANTA ROSA ST
Practice Address - Street 2:CENTER FOR CHILDREN & FAMILIES, 4TH FLOOR, CLINIC A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3108
Practice Address - Country:US
Practice Address - Phone:210-704-8810
Practice Address - Fax:210-704-4136
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK8608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1249559-07Medicaid
TXTXB160718Medicare PIN
TX1249559-07Medicaid