Provider Demographics
NPI:1336194646
Name:FAMILY HEALTH CENTER OF BENICIA
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER OF BENICIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-745-0711
Mailing Address - Street 1:1440 MILITARY W
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2446
Mailing Address - Country:US
Mailing Address - Phone:707-745-0711
Mailing Address - Fax:707-745-0788
Practice Address - Street 1:1440 MILITARY W
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2451
Practice Address - Country:US
Practice Address - Phone:707-745-0711
Practice Address - Fax:707-745-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty