Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 23209 | CA |
NPI | 1215985353 |
---|---|
Provider Name | Dr. Cynthia J. Benkert |
First Address | Mira Loma, CA 92860 |
Second Address | Mira Loma, CA 92860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 08/07/2007 |