Healthcare Provider Details

I. General information

NPI: 1437070190
Provider Name (Legal Business Name): BENAVIDEZ PHYSICIAN ASSISTANT MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 NILES STREET
BAKERSFIELD CA
93306
US

IV. Provider business mailing address

2915 NILES STREET
BAKERSFIELD CA
93306
US

V. Phone/Fax

Practice location:
  • Phone: 661-605-7911
  • Fax:
Mailing address:
  • Phone: 661-605-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VICENTE BENAVIDEZ
Title or Position: PRESIDENT
Credential: PA-C
Phone: 661-605-7911