Provider Demographics
NPI:1912175738
Name:MELISSA A. BENAVIDES, M.D., P.A.
Entity type:Organization
Organization Name:MELISSA A. BENAVIDES, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMARILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-727-1995
Mailing Address - Street 1:220 W HILLSIDE STE 4A
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6903
Mailing Address - Country:US
Mailing Address - Phone:956-727-1995
Mailing Address - Fax:956-717-1176
Practice Address - Street 1:220 W HILLSIDE STE 4A
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6903
Practice Address - Country:US
Practice Address - Phone:956-727-1995
Practice Address - Fax:956-717-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0034MHOtherBLUE CROSS BLUE SHIELD
TX124955906Medicaid
TX172430401OtherMEDICAID BILLING
TX0034MHOtherBLUE CROSS BLUE SHIELD
TX172430401OtherMEDICAID BILLING