Organization
BENACARE MEDICAL CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELINDA BENAVIDEZ (ADMINISTRATOR)
(909) 373-8222
Entity
Organization
Contact information
Practice address
984 W FOOTHILL BLVD, UPLAND, CA 91786-3700
(909) 373-8222
(877) 803-0308
Mailing address
984 W FOOTHILL BLVD, UPLAND, CA 91786-3700
(909) 373-8222
(877) 803-0308
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A6396
CA
207Q00000X
Family Medicine Physician
20A8664
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX63960
—
CA
Enumeration date
01/22/2007
Last updated
04/02/2014
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