Healthcare Provider Details

I. General information

NPI: 1073384194
Provider Name (Legal Business Name): BENER JOSEPH DEOMPOC JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E RIVER PARK PL W
FRESNO CA
93720-1551
US

IV. Provider business mailing address

1944 BAYBERRY DR
PERRIS CA
92571-3886
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-4950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number789593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: