1265588891 NPI number — IRENE GARCIA-BENAVIDES SLP

Table of content: IRENE GARCIA-BENAVIDES SLP (NPI 1265588891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265588891 NPI number — IRENE GARCIA-BENAVIDES SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA-BENAVIDES
Provider First Name:
IRENE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EASTERLY
Provider Other First Name:
IRENE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265588891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5052 LAKEWAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78520-9247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-517-9361
Provider Business Mailing Address Fax Number:
956-572-9737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5052 LAKEWAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78520-9247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-517-9361
Provider Business Practice Location Address Fax Number:
956-517-9361
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  24754 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: KY-3421 . This is a "KENTUCKY BOARD OF SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 24754 . This is a "LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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