Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 20577 | CA |
NPI | 1104342419 |
---|---|
Provider Name | Areli Del Carmen Benitez |
First Address | Cypress, CA 90630-8520 |
Second Address | Manhattan Beach, CA 90266-6876 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2017 |
Last Update Date | 10/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
94782449C | MEDI-CAL (01) |