Provider Demographics
NPI:1336198415
Name:GARCIA DE BENITEZ, MARIA SOCORRO (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:SOCORRO
Last Name:GARCIA DE BENITEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 H ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2819
Mailing Address - Country:US
Mailing Address - Phone:661-635-3000
Mailing Address - Fax:661-635-3006
Practice Address - Street 1:1815 W REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8054
Practice Address - Country:US
Practice Address - Phone:909-289-4075
Practice Address - Fax:909-363-8233
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A632290Medicaid
CAA63229Medicare ID - Type Unspecified
CA0A632290Medicaid