| Benedicto M. Estoesta M.d. Inc | |
|
55 S Highway 26 Ste 1 Valley Springs CA 95252-8422 | |
| (209) 772-8906 | |
| (209) 772-8950 |
| Full Name | Benedicto M. Estoesta M.d. Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 55 S Highway 26 Ste 1, Valley Springs, California |
| Authorized Official Name and Position | Benedicto Mercado Estoesta (PRESIDENT) |
| Authorized Official Contact | 2097728906 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Benedicto M. Estoesta M.d. Inc 55 S Highway 26 Ste 1 P O Box 1570 Valley Springs CA 95252-8422 Ph: (209) 772-8906 | Benedicto M. Estoesta M.d. Inc 55 S Highway 26 Ste 1 Valley Springs CA 95252-8422 Ph: (209) 772-8906 |
| NPI Number | 1538157953 |
|---|---|
| Provider Enumeration Date | 10/10/2005 |
| Last Update Date | 02/04/2013 |
| Medicare PECOS PAC ID | 9436113131 |
|---|---|
| Medicare Enrollment ID | O20041112000704 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538157953 | NPI | - | NPPES |
| GR0095330 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | A49318 (California) | Secondary |
| 207Q00000X | Family Medicine | A49318 (California) | Primary |
| Provider Name | Benedicto M Estoesta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649451071 PECOS PAC ID: 1456244995 Enrollment ID: I20040206000621 |
Mark Twain Health Care District Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 51 Wellness Way, Valley Springs, CA 95252 Phone: 209-772-7070 Fax: 209-772-1011 |