Individual
MR. BENNIE BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
1904 RICHLAND AVE, CERES, CA 95307-4562
(209) 312-7057
Mailing address
1904 RICHLAND AVE, CERES, CA 95307
(209) 312-7057
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN186764
CA
Other
Enumeration date
08/12/2016
Last updated
09/08/2016
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