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Contact Information

GUY BENNALLACK JR
1400 E CHURCH ST BLDG 8
SANTA MARIA, CA93454
 Phone: 805-739-3561
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Emergency Medicine

207P00000X 93 Physician/Emergency Medicine
Indicates primary specialty

NPI Profile & details for GUY BENNALLACK JR · (Male)

NPI Number 1245610344
Status Active
Credentials
Entity Individual
Enumeration date 06/03/2015
Last updated 07/25/2018 - More than a year ago
Sole proprietor 1 Yes
Identifiers
  • CA License # 20A15415
  • CA License # XXXXXXXXXX
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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