Provider Demographics
NPI:1174798359
Name:MASCARENAS-BENAVIDEZ, LORETTA MONIQUE
Entity type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:MONIQUE
Last Name:MASCARENAS-BENAVIDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 LOUISIANA BLVD SE APT 513
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3952
Mailing Address - Country:US
Mailing Address - Phone:505-712-7424
Mailing Address - Fax:505-232-6621
Practice Address - Street 1:820 LOUISIANA BLVD SE APT 513
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3952
Practice Address - Country:US
Practice Address - Phone:505-712-7424
Practice Address - Fax:505-232-6621
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator