Healthcare Provider Details

I. General information

NPI: 1336194646
Provider Name (Legal Business Name): FAMILY HEALTH CENTER OF BENICIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 MILITARY W
BENICIA CA
94510-2451
US

IV. Provider business mailing address

1440 MILITARY W
BENICIA CA
94510-2446
US

V. Phone/Fax

Practice location:
  • Phone: 707-745-0711
  • Fax: 707-745-0788
Mailing address:
  • Phone: 707-745-0711
  • Fax: 707-745-0788

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: MS. NANETTE C BENNETT
Title or Position: OFFICE MANAGER
Credential:
Phone: 707-745-0711