Provider Demographics
NPI:1346239613
Name:BENABAYE, ALBINA GONZALEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBINA
Middle Name:GONZALEZ
Last Name:BENABAYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1434
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-1434
Mailing Address - Country:US
Mailing Address - Phone:209-462-7277
Mailing Address - Fax:866-950-0134
Practice Address - Street 1:1503 E MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-5622
Practice Address - Country:US
Practice Address - Phone:209-462-7277
Practice Address - Fax:866-950-0134
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA337490207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337490Medicaid
CA00A337490Medicare ID - Type Unspecified
CA00A337490Medicaid