Healthcare Provider Details

I. General information

NPI: 1720738131
Provider Name (Legal Business Name): ANDRES BENINCORE ROBLEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1186 LELAND AVE
TULARE CA
93274-7811
US

IV. Provider business mailing address

1201 N CHERRY ST
TULARE CA
93274-2233
US

V. Phone/Fax

Practice location:
  • Phone: 559-686-9097
  • Fax:
Mailing address:
  • Phone: 559-631-4042
  • Fax: 559-366-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP4
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: