Healthcare Provider Details

I. General information

NPI: 1982539755
Provider Name (Legal Business Name): DAVID LAWRENCE BENAVIDES NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 VISTA WAY STE 105
OCEANSIDE CA
92054-6178
US

IV. Provider business mailing address

3340 JASMINE PL
ESCONDIDO CA
92025-7604
US

V. Phone/Fax

Practice location:
  • Phone: 858-209-3717
  • Fax:
Mailing address:
  • Phone: 619-318-1079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: