Healthcare Provider Details

I. General information

NPI: 1366783094
Provider Name (Legal Business Name): MARKIE BENAVIDEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

IV. Provider business mailing address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MARKIE BENAVIDEZ
Title or Position: CLINIC COORDINATOR
Credential:
Phone: 916-734-7251