1952421588 NPI number — MS. NORMA WILDER BENAVIDES MFT

Table of content: MS. NORMA WILDER BENAVIDES MFT (NPI 1952421588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952421588 NPI number — MS. NORMA WILDER BENAVIDES MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENAVIDES
Provider First Name:
NORMA
Provider Middle Name:
WILDER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILDER
Provider Other First Name:
NORMA
Provider Other Middle Name:
ROYALE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952421588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 W VICTORIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93101-3628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-564-8606
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 E CARRILLO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93101-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-882-3715
Provider Business Practice Location Address Fax Number:
805-882-3764
Provider Enumeration Date:
03/29/2007

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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