Provider Demographics
NPI:1184138182
Name:BENITEZ, ARACELY
Entity type:Individual
Prefix:
First Name:ARACELY
Middle Name:
Last Name:BENITEZ
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 1:10921 PELLICANO DR STE 128
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4618
Mailing Address - Country:US
Mailing Address - Phone:915-249-4036
Mailing Address - Fax:
Practice Address - Street 1:10921 PELLICANO DR STE 128
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4618
Practice Address - Country:US
Practice Address - Phone:915-249-4036
Practice Address - Fax:915-642-6730
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX018219251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health