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NPI Code Detail

MEDICARE: DR. JOYCE BENAVIDES MEDINA O.D.

MEDICARE:  DR. JOYCE BENAVIDES MEDINA  O.D.
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
1152W00000XOptometrist10675TCA

General Provider Information

NPI Number : 1700937299
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOYCE BENAVIDES MEDINA O.D.
Provider Business Mailing Address
First Line : 1010 UNIVERSITY AVENUE
Second Line : SUITE C109
City : SAN DIEGO
State : CA
Zip : 92103
Country : US
Telephone Number : 619-955-5369
Fax Number : 619-329-4369
Provider Business Practice Location Address
First Line : 1010 UNIVERSITY AVENUE
Second Line : SUITE C109
City : SAN DIEGO
State : CA
Zip : 92103
Country : US
Telephone Number : 619-955-5369
Fax Number : 619-329-4369
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2007
Last Update Date : 08/10/2020

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Directions to “ DR. JOYCE BENAVIDES MEDINA O.D.” Practice Location

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