1942510797 NPI number — MRS. HAZEL ANNE PERILLA BENAVIDES

Table of content: MRS. HAZEL ANNE PERILLA BENAVIDES (NPI 1942510797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942510797 NPI number — MRS. HAZEL ANNE PERILLA BENAVIDES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENAVIDES
Provider First Name:
HAZEL ANNE
Provider Middle Name:
PERILLA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERILLA
Provider Other First Name:
HAZEL ANNE
Provider Other Middle Name:
SANIDAD
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942510797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8215 JADE COAST RD.
Provider Second Line Business Mailing Address:
UNIT # 84
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92126-6462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-610-5967
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8215 JADE COAST RD.
Provider Second Line Business Practice Location Address:
UNIT # 84
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126-6462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-610-5967
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  74261 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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