Healthcare Provider Details

I. General information

NPI: 1982524112
Provider Name (Legal Business Name): MACARENA PAZ BENAVENTE PENA MS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 BROADWAY AVE
ATWATER CA
95301-3546
US

IV. Provider business mailing address

903 SAN PABLO AVE
MERCED CA
95348-2229
US

V. Phone/Fax

Practice location:
  • Phone: 209-357-6100
  • Fax:
Mailing address:
  • Phone: 209-357-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number33728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: