Provider Demographics
NPI:1992247290
Name:JESSE BENITEZ JR.
Entity type:Organization
Organization Name:JESSE BENITEZ JR.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:210-384-4665
Mailing Address - Street 1:7330 REINDEER TRL
Mailing Address - Street 2:
Mailing Address - City:LEON VALLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1273
Mailing Address - Country:US
Mailing Address - Phone:210-384-4665
Mailing Address - Fax:210-568-4205
Practice Address - Street 1:7330 REINDEER TRL
Practice Address - Street 2:
Practice Address - City:LEON VALLEY
Practice Address - State:TX
Practice Address - Zip Code:78238-1273
Practice Address - Country:US
Practice Address - Phone:210-384-4665
Practice Address - Fax:210-568-4205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies