Provider Demographics
NPI:1356615421
Name:BENAVIDEZ, VICENTE AUDONI (PA-C)
Entity type:Individual
Prefix:
First Name:VICENTE
Middle Name:AUDONI
Last Name:BENAVIDEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:VICENTE
Other - Middle Name:AUDONI
Other - Last Name:BENAVIDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2145 NILES ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-5007
Mailing Address - Country:US
Mailing Address - Phone:661-327-5984
Mailing Address - Fax:661-327-2541
Practice Address - Street 1:2145 NILES ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-5007
Practice Address - Country:US
Practice Address - Phone:661-327-5984
Practice Address - Fax:661-327-2541
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22414363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical