Individual
VANESSA NICOLE BENAVIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
308 S CESAR CHAVEZ AVE, CRYSTAL CITY, TX 78839-4200
(830) 374-2301
Mailing address
601 W WEBB ST, CRYSTAL CITY, TX 78839-3825
(830) 374-6968
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
79381
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101
—
TX
Enumeration date
03/18/2020
Last updated
03/18/2020
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