Provider Demographics
NPI:1578281622
Name:FERNANDEZ, BENJAMIN CESAR VILLEGAS (LVN)
Entity Type:Individual
Prefix:
First Name:BENJAMIN CESAR
Middle Name:VILLEGAS
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8468 LUCIA ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6302
Mailing Address - Country:US
Mailing Address - Phone:909-275-1952
Mailing Address - Fax:
Practice Address - Street 1:8468 LUCIA ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-6302
Practice Address - Country:US
Practice Address - Phone:909-275-1952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)