Basic Information
| Provider Information | |||||||||
| NPI: | 1184004269 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN BENITO HEALTH FOUNDATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 351 FELICE DR | ||||||||
| Address2: | |||||||||
| City: | HOLLISTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316376871 | ||||||||
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| Practice Location | |||||||||
| Address1: | 351 FELICE DR | ||||||||
| Address2: | |||||||||
| City: | HOLLISTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316376871 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2015 | ||||||||
| LastUpdateDate: | 06/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | FERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | ROSA VIVIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8316376871 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 070000136 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.