Provider Demographics
NPI:1861485732
Name:CUSHINGBERRY - TURNER, BENITA LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:BENITA
Middle Name:LISA
Last Name:CUSHINGBERRY - TURNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BENITA
Other - Middle Name:LISA
Other - Last Name:CUSHINGBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5601 AUBURN ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-2977
Mailing Address - Country:US
Mailing Address - Phone:661-616-9700
Mailing Address - Fax:661-616-9719
Practice Address - Street 1:5601 AUBURN ST UNIT A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-2977
Practice Address - Country:US
Practice Address - Phone:661-616-9700
Practice Address - Fax:661-616-9719
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2013-09-16
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-06-27
Provider Licenses
StateLicense IDTaxonomies
CAA52758207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A527580Medicaid
CAG11040Medicare UPIN
MS302I087639Medicare PIN
CA00A527580Medicare ID - Type Unspecified