Active NPI
Abraham Benavides, MD
- Student in an Organized Health Care Education/Training Program
- Pueblo, CO
National Provider Identifier
1952864274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- TL.0007818
- Practice address
- 902 Lakeview Ave
Pueblo, CO 81004-3597 - Phone
- (719) 557-5872
- Fax
- (719) 557-4780
- NPI assigned
- Apr 12, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | TL.0007818 | CO | |
| Student in an Organized Health Care Education/Training Program | 390200000X | TL.0007818 | CO | Primary |
Addresses
Primary practice location
902 Lakeview Ave
Pueblo, CO 81004-3597
Mailing address
902 Lakeview Ave
Pueblo, CO 81004-3597
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TL.0007818 | CO | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559001600000",
"number": "1952864274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "902 LAKEVIEW AVE",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810043597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "902 LAKEVIEW AVE",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810043597",
"telephone_number": "719-557-5872",
"fax_number": "719-557-4780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENAVIDES",
"first_name": "ABRAHAM",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-12",
"last_updated": "2019-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CO",
"license": "TL.0007818",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CO",
"license": "TL.0007818",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.