Provider Demographics
NPI:1992430698
Name:BENDEZU, JASON JOSE (LP)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:JOSE
Last Name:BENDEZU
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-3410
Mailing Address - Country:US
Mailing Address - Phone:786-390-8400
Mailing Address - Fax:
Practice Address - Street 1:2404 2ND ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3410
Practice Address - Country:US
Practice Address - Phone:786-390-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent