Healthcare Provider Details

I. General information

NPI: 1174577613
Provider Name (Legal Business Name): BENSON FAMILY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41555 COOK ST STE 130
PALM DESERT CA
92211
US

IV. Provider business mailing address

41555 COOK ST STE 130
PALM DESERT CA
92211
US

V. Phone/Fax

Practice location:
  • Phone: 760-340-2682
  • Fax: 760-773-9695
Mailing address:
  • Phone: 760-340-2682
  • Fax: 760-773-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A5361
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A4564
License Number StateCA

VIII. Authorized Official

Name: AURORA L BENSON
Title or Position: PRESIDENT
Credential: DO
Phone: 760-340-2682