Healthcare Provider Details

I. General information

NPI: 1013859511
Provider Name (Legal Business Name): GUSTAVO ARTURO BENITEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HIGH ST STE 107
AUBURN CA
95603-4228
US

IV. Provider business mailing address

PO BOX 4039
AUBURN CA
95604-4039
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-1111
  • Fax:
Mailing address:
  • Phone: 530-885-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: