Provider Demographics
NPI:1336670405
Name:BENAVIDEZ, JULIAN R (MD)
Entity type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:R
Last Name:BENAVIDEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3630 LAS ESTANCIAS DR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-5504
Mailing Address - Country:US
Mailing Address - Phone:505-462-7777
Mailing Address - Fax:505-462-7780
Practice Address - Street 1:3630 LAS ESTANCIAS DR SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-5504
Practice Address - Country:US
Practice Address - Phone:505-462-7777
Practice Address - Fax:505-462-7780
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0063829208000000X
NMMD2020-0556208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics