Provider Demographics
NPI:1659006864
Name:SAN BENITO FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:SAN BENITO FAMILY PRACTICE, INC.
Other - Org Name:SAN BENITO PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:I
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-626-1444
Mailing Address - Street 1:11012 AIRLINE DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-1112
Mailing Address - Country:US
Mailing Address - Phone:281-820-8955
Mailing Address - Fax:281-667-3275
Practice Address - Street 1:400 W HWY 77
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-5148
Practice Address - Country:US
Practice Address - Phone:956-626-1444
Practice Address - Fax:956-626-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty