Provider Demographics
NPI:1083617096
Name:VALDEZ, BENJAMIN FERNANDEZ (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:FERNANDEZ
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 PARK DR
Mailing Address - Street 2:STE 104
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5562
Mailing Address - Country:US
Mailing Address - Phone:916-677-8570
Mailing Address - Fax:916-677-8575
Practice Address - Street 1:5440 PARK DR
Practice Address - Street 2:STE 104
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5562
Practice Address - Country:US
Practice Address - Phone:916-677-8570
Practice Address - Fax:916-677-8575
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG068466208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G684660Medicare ID - Type Unspecified