Individual
GLENN ANTHONY BENAVIDEZ JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1300 EAST RIVER RD., BELEN, NM 87002-8706
(505) 312-0040
Mailing address
PO BOX 292, TOME, NM 87060-0292
(505) 312-0040
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
02/03/2021
Last updated
02/03/2021
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