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: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

892 AEROVISTA PL STE 120
SAN LUIS OBISPO CA
93401-8054
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 805-544-5567
  • 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: