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General NPI Number Information
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NPI Number | 1780891739
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Entity Type | Individual
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Provider Name | RAYMOND M. BENTON FNP
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 101 NORTH PALM STREET
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City | WOODLAKE
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State | CA
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Zip | 93286-1422
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Country | US
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Telephone | 559-564-0100
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Fax | 559-564-2285
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Provider Business Mailing Address
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Address Line | 305 EAST CENTER AVE.
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City | VISALIA
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State | CA
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Zip | 93291-6331
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Country | US
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Telephone | 559-737-4700
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Fax | 559-737-4782
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 231382
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | FNP3802
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License Number State | CA
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