Provider Demographics
NPI:1942603758
Name:MARIDEL FRANCISCO BENIGNO RDHAP
Entity Type:Organization
Organization Name:MARIDEL FRANCISCO BENIGNO RDHAP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIDEL
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:BENIGNO
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:916-271-5711
Mailing Address - Street 1:8936 CAPOTE WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8026
Mailing Address - Country:US
Mailing Address - Phone:916-271-5711
Mailing Address - Fax:
Practice Address - Street 1:8936 CAPOTE WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8026
Practice Address - Country:US
Practice Address - Phone:916-271-5711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP541124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty