Active NPI
Odelman Blanco Benavides, SA-C
- Surgical Assistant
- Houston, TX
National Provider Identifier
1871004424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 17-546
- Practice address
- 18001 Cypress Trace Rd Apt 3301
Houston, TX 77090-1408 - Phone
- (832) 475-7498
- NPI assigned
- Oct 22, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 17-546 | WI | Primary |
Addresses
Primary practice location
18001 Cypress Trace Rd Apt 3301
Houston, TX 77090-1408
Mailing address
18001 Cypress Trace Rd Apt 3301
Houston, TX 77090-1408
Phone (832) 475-7498
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 |
|---|---|---|---|
| 17-546 | WI | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508630400000",
"number": "1871004424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18001 CYPRESS TRACE RD APT 3301",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770901408",
"telephone_number": "832-475-7498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18001 CYPRESS TRACE RD APT 3301",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770901408",
"telephone_number": "832-475-7498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANCO BENAVIDES",
"first_name": "ODELMAN",
"credential": "SA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-22",
"last_updated": "2017-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "WI",
"license": "17-546",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.