Provider Demographics
NPI:1386971794
Name:BENITEZ, SAUL JR (ACNS)
Entity type:Individual
Prefix:
First Name:SAUL
Middle Name:
Last Name:BENITEZ
Suffix:JR
Gender:M
Credentials:ACNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 JAMES CASEY ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3325
Mailing Address - Country:US
Mailing Address - Phone:512-816-8042
Mailing Address - Fax:512-804-2360
Practice Address - Street 1:4101 JAMES CASEY ST
Practice Address - Street 2:SUITE 330
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3325
Practice Address - Country:US
Practice Address - Phone:512-816-8042
Practice Address - Fax:512-804-2360
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX747353364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211153603Medicaid
TX831N38OtherBCBS
TX211153602Medicaid
TXP00976278OtherRAILROAD MEDICARE
TXTXB117793Medicare PIN
TXP00976278OtherRAILROAD MEDICARE