Healthcare Provider Details

I. General information

NPI: 1134295801
Provider Name (Legal Business Name): EILEEN H BENWAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 SAN MIGUEL DR SUITE 310
WALNUT CREEK CA
94596-4962
US

IV. Provider business mailing address

1844 SAN MIGUEL DR SUITE 310
WALNUT CREEK CA
94596-4962
US

V. Phone/Fax

Practice location:
  • Phone: 925-937-6000
  • Fax: 925-937-2823
Mailing address:
  • Phone: 925-937-6000
  • Fax: 925-937-2823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA060503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: