Provider Demographics
NPI:1669704482
Name:COMPCARE MEDICAL INC.
Entity type:Organization
Organization Name:COMPCARE MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALPHONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-606-8767
Mailing Address - Street 1:15944 LOS SERRANOS COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4523
Mailing Address - Country:US
Mailing Address - Phone:909-606-8767
Mailing Address - Fax:909-597-8681
Practice Address - Street 1:15944 LOS SERRANOS COUNTRY CLUB DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-4523
Practice Address - Country:US
Practice Address - Phone:909-606-8767
Practice Address - Fax:909-597-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H99608Medicare UPIN
H50704Medicare UPIN