Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 95003887 | CA |
NPI | 1003362781 |
---|---|
Provider Name | Diana Benitez |
First Address | Los Angeles, CA 90007-3320 |
Second Address | Los Angeles, CA 90007-3320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2016 |
Last Update Date | 31/08/2016 |