Provider Demographics
NPI:1366531691
Name:BENITEZ, ROLANDO (MPAS, PA-C)
Entity type:Individual
Prefix:MR
First Name:ROLANDO
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E NOLANA AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6113
Mailing Address - Country:US
Mailing Address - Phone:956-668-7333
Mailing Address - Fax:956-668-7999
Practice Address - Street 1:801 E NOLANA AVE STE 6
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6113
Practice Address - Country:US
Practice Address - Phone:956-668-7333
Practice Address - Fax:956-668-7999
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00822363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80N560Medicare ID - Type Unspecified
TXS20302Medicare UPIN