Provider Demographics
NPI:1053029694
Name:BENAVIDES, IVONNE EDUALETTE
Entity type:Individual
Prefix:MRS
First Name:IVONNE
Middle Name:EDUALETTE
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7285 PLEASANT BEND DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-1220
Mailing Address - Country:US
Mailing Address - Phone:832-495-1511
Mailing Address - Fax:
Practice Address - Street 1:7285 PLEASANT BEND DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-1220
Practice Address - Country:US
Practice Address - Phone:832-495-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician