| Doctor Name: | MR. MICHAEL THOMAS BENAVIDEZ |
| NPI Number: | 1053579516 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 7575 Red Bud Rd Granite Bay, CA - 957469511 |
| Business Phone Number: | 9167087290 |
| Business Fax Number: | |
| Mailing Address: | 7575 Red Bud Rd, GRANITE BAY |
| State: | CA |
| Postal Code: | 957469511 |
| Phone Number: | 9167087290 |
| Fax Number: | |
| NPI Enumeration Date: | 05/30/2008 |
| NPI Last Update Date: | 06/02/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2470A2800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Technician, Health Information |
| Taxonomy Specialization: | Assistant Record Technician |
| Taxonomy Definition: | |