Maribel Benavides, EIS
Individual provider Active NPI Developmental Therapist · Lytle, TX
NPI 1639470412 · NPPES record last updated Nov 9, 2010
Key facts
- NPI
- 1639470412
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Developmental Therapist 222Q00000X
- License
- 990012 (TX)
- Practice address
- 19965 FM 3175
Lytle, TX 78052-3481 - Phone
- (210) 357-0395
- Fax
- (830) 709-5493
- NPI assigned
- Nov 9, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 990012 | TX | MD | Developmental Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | 990012 | TX | Yes |
Addresses
Primary practice location
19965 FM 3175
Lytle, TX 78052-3481
Mailing address
PO Box 725
Lytle, TX 78052-0725
Phone (210) 357-0395
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 99-0012 | Other | TX | LICENSE OTHER |
Other providers in Lytle, TX
- Atascosa Health Center, Inc.
- Linda Louise Atwood
- Carolyn J Barnette
- Patricia Barrera
- Esther G. Basaldua
- Lauren Billings
- Larry Wayne Bohmfalk
- Karla Elizabeth Bowman
- Maria Louise Brochu
- Fahimah Yazdanfard Callahan
All providers in Lytle, TX · Developmental Therapist in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.