Healthcare Provider Details

I. General information

NPI: 1104787134
Provider Name (Legal Business Name): BENEDICT TRINIDAD SAMONTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 TENNESSEE ST
VALLEJO CA
94590-4654
US

IV. Provider business mailing address

4280 MELODY LN
VALLEJO CA
94591-6352
US

V. Phone/Fax

Practice location:
  • Phone: 707-563-9010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: