Provider Demographics
NPI:1780246439
Name:BENITEZ, ANNA PRISCILLA (MSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:PRISCILLA
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 HIGHLAND AVE # 1134
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2512
Mailing Address - Country:US
Mailing Address - Phone:626-636-1535
Mailing Address - Fax:
Practice Address - Street 1:44750 60TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-7619
Practice Address - Country:US
Practice Address - Phone:626-636-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2023-09-02
Deactivation Date:2021-02-09
Deactivation Code:
Reactivation Date:2023-08-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program