Individual
MR. JONATHAN ALEXANDER BENAVIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
6506 LAZY WILLOW COURT, CORPUS CHRISTI, TX 78412-4857
(361) 236-9800
Mailing address
6506 LAZY WILLOW COURT, CORPUS CHRISTI, TX 78412-4857
(361) 236-9800
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000017616
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000017616
ATHLETIC TRAINER
TX
Enumeration date
07/05/2014
Last updated
07/05/2014
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