Individual
BENJAMIN OLMEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
217 W CENTRAL AVE STE G, LOMPOC, CA 93436-2830
(805) 735-4292
(805) 735-4293
Mailing address
217 W CENTRAL AVE STE G, LOMPOC, CA 93436-2830
(805) 735-4292
(805) 735-4293
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1039
AK
363AM0700X
Medical Physician Assistant
Primary
PA52451
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MDA0484
—
AK
05
—
MDA0484
—
CA
Enumeration date
04/04/2012
Last updated
11/03/2023
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