Provider Demographics
NPI:1053388819
Name:BENITES, GABRIEL M (PA-C)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:M
Last Name:BENITES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 WALZEM RD STE 5340
Mailing Address - Street 2:
Mailing Address - City:WINDCREST
Mailing Address - State:TX
Mailing Address - Zip Code:78218-2123
Mailing Address - Country:US
Mailing Address - Phone:210-653-8085
Mailing Address - Fax:210-599-8508
Practice Address - Street 1:5340 WALZEM RD STE 5340
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78218-2123
Practice Address - Country:US
Practice Address - Phone:210-653-8085
Practice Address - Fax:210-599-8508
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01916363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309254601Medicaid