Healthcare Provider Details

I. General information

NPI: 1760338859
Provider Name (Legal Business Name): ANGELA BENADOM LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W INYOKERN RD STE B
RIDGECREST CA
93555-2370
US

IV. Provider business mailing address

1111 W INYOKERN RD
RIDGECREST CA
93555-2370
US

V. Phone/Fax

Practice location:
  • Phone: 760-301-6945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number244250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: