Provider Demographics
NPI:1144529926
Name:BENESCH, ERIN (DO)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:
Last Name:BENESCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1100B N TUSTIN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12511 BROOKHURST ST
Practice Address - Street 2:2 FL
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4806
Practice Address - Country:US
Practice Address - Phone:714-534-3681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-20
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A124652084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry