Provider Demographics
NPI:1003143751
Name:SAN BENITO HEALTH FOUNDATION
Entity Type:Organization
Organization Name:SAN BENITO HEALTH FOUNDATION
Other - Org Name:COMMUNITY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL ASSISTANT I
Authorized Official - Prefix:
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABONCE
Authorized Official - Suffix:
Authorized Official - Credentials:MA/AAS
Authorized Official - Phone:831-637-5306
Mailing Address - Street 1:351 FELICE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3361
Mailing Address - Country:US
Mailing Address - Phone:831-637-5306
Mailing Address - Fax:831-637-5842
Practice Address - Street 1:351 FELICE DRIVE
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023
Practice Address - Country:US
Practice Address - Phone:831-637-5306
Practice Address - Fax:831-637-5842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization