Healthcare Provider Details

I. General information

NPI: 1649451071
Provider Name (Legal Business Name): BENEDICTO M ESTOESTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S HIGHWAY 26 STE 1
VALLEY SPRINGS CA
95252-8422
US

IV. Provider business mailing address

55 S HIGHWAY 26 STE 1
VALLEY SPRINGS CA
95252-8422
US

V. Phone/Fax

Practice location:
  • Phone: 209-772-8906
  • Fax: 209-772-8950
Mailing address:
  • Phone: 209-772-8906
  • Fax: 209-772-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberA49318
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA49318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: