Healthcare Provider Details

I. General information

NPI: 1184464976
Provider Name (Legal Business Name): CARLOS BENITEZ YNIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1288
MADERA CA
93639-1288
US

IV. Provider business mailing address

18668 SHELL DR
MADERA CA
93638-0284
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-3508
  • Fax:
Mailing address:
  • Phone: 559-660-2897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: