MEDICARE: BENEDICTO M. ESTOESTA M.D. INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	A49318	CA
2	207Q00000X	Family Medicine Physician	A49318	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538157953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENEDICTO M. ESTOESTA M.D. INC

Provider Business Mailing Address
First Line	:	55 S HIGHWAY 26 STE 1
Second Line	:	P O BOX 1570
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-8422
Country	:	US
Telephone Number	:	209-772-8906
Fax Number	:	209-772-8950

Provider Business Practice Location Address
First Line	:	55 S HIGHWAY 26 STE 1
Second Line	:
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-8422
Country	:	US
Telephone Number	:	209-772-8906
Fax Number	:	209-772-8950

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BENEDICTO MERCADO ESTOESTA
Credential	:	MD
Telephone Number	:	209-772-8906

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	02/04/2013

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