Healthcare Provider Details

I. General information

NPI: 1144133109
Provider Name (Legal Business Name): WEST COAST ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S MAIN ST
CORONA CA
92882-2531
US

IV. Provider business mailing address

12883 ROCK CREST LN
CHINO HILLS CA
91709-1143
US

V. Phone/Fax

Practice location:
  • Phone: 909-618-5398
  • Fax:
Mailing address:
  • Phone: 909-618-5398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD A BENAVIDEZ
Title or Position: PHYSICIAN ASSISTANT
Credential: PA
Phone: 909-618-5398