1851557516 NPI number — CHERYL MOANA MARIE BENITEZ M.A.

Table of content: CHERYL MOANA MARIE BENITEZ M.A. (NPI 1851557516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851557516 NPI number — CHERYL MOANA MARIE BENITEZ M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENITEZ
Provider First Name:
CHERYL
Provider Middle Name:
MOANA MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENITEZ MOLINA
Provider Other First Name:
CHERYL
Provider Other Middle Name:
MOANA MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1851557516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35831 GLISSANT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92596-9150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-514-1756
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35831 GLISSANT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92596-9150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
519-514-1756
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2008

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: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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