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General NPI Number Information
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NPI Number | 1427101369
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Entity Type | Organization
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Legal Business Name | BENACARE MEDICAL CENTER, INC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 04/02/2014
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Provider Practice Location Address
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Address Line | 984 W FOOTHILL BLVD
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City | UPLAND
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State | CA
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Zip | 91786-3700
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Country | US
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Telephone | 909-373-8222
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Fax | 877-803-0308
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Provider Business Mailing Address
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Address Line | 984 W FOOTHILL BLVD
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City | UPLAND
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State | CA
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Zip | 91786-3700
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Country | US
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Telephone | 909-373-8222
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Fax | 877-803-0308
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MELINDA BENAVIDEZ
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Credential |
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Telephone | 909-373-8222
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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 | 20A8664
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License Number State | CA
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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 | 20A6396
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License Number State | CA
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