Individual
JOSEPH MICA BENAVIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6425 COLUMBINE RD., OAK HILLS, CA 92344
(760) 686-7837
Mailing address
6425 COLUMBINE RD, OAK HILLS, CA 92344-0753
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
116671
AK
Other
Enumeration date
05/08/2018
Last updated
05/08/2018
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