Provider Demographics
NPI:1649451071
Name:ESTOESTA, BENEDICTO M (MD)
Entity type:Individual
Prefix:DR
First Name:BENEDICTO
Middle Name:M
Last Name:ESTOESTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 S HIGHWAY 26 STE 1
Mailing Address - Street 2:
Mailing Address - City:VALLEY SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95252-8422
Mailing Address - Country:US
Mailing Address - Phone:209-772-8906
Mailing Address - Fax:209-772-8950
Practice Address - Street 1:55 S HIGHWAY 26 STE 1
Practice Address - Street 2:
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252-8422
Practice Address - Country:US
Practice Address - Phone:209-772-8906
Practice Address - Fax:209-772-8950
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49318171100000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A493183Medicare PIN