Individual
MARCELO BENVENISTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4000
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
42646
TX
2085R0202X
Diagnostic Radiology Physician
Primary
P4930
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207943601
—
TX
01
—
207943602
MEDICAID CSHCN
TX
01
—
8W0999
BCBS
TX
01
—
P00803068
RR MEDICARE
TX
Enumeration date
10/20/2009
Last updated
01/20/2021
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