Healthcare Provider Details

I. General information

NPI: 1598630899
Provider Name (Legal Business Name): KRISTEN BENZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 OAK PARK BLVD STE 101
PISMO BEACH CA
93449-3403
US

IV. Provider business mailing address

151 W BRANCH ST STE E
ARROYO GRANDE CA
93420-2646
US

V. Phone/Fax

Practice location:
  • Phone: 805-574-4037
  • Fax:
Mailing address:
  • Phone: 510-894-9762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberNA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: