| Benacare Medical Center, Inc | |
|
984 W Foothill Blvd Upland CA 91786-3700 | |
| (909) 373-8222 | |
| (877) 803-0308 |
| Full Name | Benacare Medical Center, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 984 W Foothill Blvd, Upland, California |
| Authorized Official Name and Position | Melinda Benavidez (ADMINISTRATOR) |
| Authorized Official Contact | 9093738222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Benacare Medical Center, Inc 984 W Foothill Blvd Upland CA 91786-3700 Ph: (909) 373-8222 | Benacare Medical Center, Inc 984 W Foothill Blvd Upland CA 91786-3700 Ph: (909) 373-8222 |
| NPI Number | 1427101369 |
|---|---|
| Provider Enumeration Date | 01/22/2007 |
| Last Update Date | 04/02/2014 |
| Medicare PECOS PAC ID | 3476543695 |
|---|---|
| Medicare Enrollment ID | O20040518000450 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427101369 | NPI | - | NPPES |
| 00AX63960 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A6396 (California) | Primary |
| 207Q00000X | Family Medicine | 20A8664 (California) | Secondary |
| Provider Name | Michael A Benavidez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205987914 PECOS PAC ID: 8527058759 Enrollment ID: I20040521001214 |
| Provider Name | Gisella V Olivares |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821138405 PECOS PAC ID: 1951381490 Enrollment ID: I20040723000898 |
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