Individual
MR. CHARLES HENRY BENAFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN, PHN
Contact information
Practice address
4738 GROUSE RUN DR, STOCKTON, CA 95207-5361
(209) 675-1472
Mailing address
4738 GROUSE RUN DR, STOCKTON, CA 95207-5361
(209) 675-1472
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
821565
CA
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
821565
CA
Other
Enumeration date
09/24/2012
Last updated
10/09/2015
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