Healthcare Provider Details

I. General information

NPI: 1992874432
Provider Name (Legal Business Name): BENNY ELZY FRANCO LPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FOSTER RD
SANTA MARIA CA
93455-3620
US

IV. Provider business mailing address

1223 SAPPHIRE DR
SANTA MARIA CA
93454-3255
US

V. Phone/Fax

Practice location:
  • Phone: 805-934-6385
  • Fax:
Mailing address:
  • Phone: 805-925-8056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT 29376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: