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General NPI Number Information
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NPI Number | 1295762326
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Entity Type | Individual
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Provider Name | BENJAMIN DOMINGO DACULA MD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 4502 E AVENUE S
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City | PALMDALE
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State | CA
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Zip | 93552-4480
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Country | US
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Telephone | 877-554-4404
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Fax |
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Provider Business Mailing Address
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Address Line | 4502 E AVENUE S
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City | PALMDALE
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State | CA
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Zip | 93552-4480
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Country | US
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Telephone | 877-554-4404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 40182
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25149
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C54857
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License Number State | CA
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