Active NPI
Angelica Kathleen Benavidez, CCC-SLP
- Speech-Language Pathologist
- Albuquerque, NM
National Provider Identifier
1114010634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2741
- Practice address
- 836 Marie Park Dr NE
Albuquerque, NM 87123-1719 - Phone
- (505) 362-3909
- Fax
- (505) 323-5392
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2741 | NM | Primary |
Addresses
Primary practice location
836 Marie Park Dr NE
Albuquerque, NM 87123-1719
Mailing address
836 Marie Park Dr NE
Albuquerque, NM 87123-1719
Phone (505) 362-3909
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B7988 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2741 | NM | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1114010634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "836 MARIE PARK DR NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871231719",
"telephone_number": "505-362-3909",
"fax_number": "505-323-5392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "836 MARIE PARK DR NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871231719",
"telephone_number": "505-362-3909",
"fax_number": "505-323-5392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENAVIDEZ",
"first_name": "ANGELICA",
"middle_name": "KATHLEEN",
"name_prefix": "Mrs.",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "2741",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "B7988",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.