Provider Demographics
NPI:1578182739
Name:BENITEZ, CECIL MAYRA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:CECIL
Middle Name:MAYRA
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 SAN BERNARDINO RD STE 1100
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4952
Practice Address - Country:US
Practice Address - Phone:909-949-2242
Practice Address - Fax:909-981-5783
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1889872085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology