Healthcare Provider Details

I. General information

NPI: 1801956990
Provider Name (Legal Business Name): MR. JOSHUA A BENENTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 S EL CAJON CIR
SPRINGERVILLE AZ
85938-5316
US

IV. Provider business mailing address

428 S EL CAJON CIR
SPRINGERVILLE AZ
85938-5316
US

V. Phone/Fax

Practice location:
  • Phone: 928-551-7731
  • Fax:
Mailing address:
  • Phone: 928-551-7731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: