Healthcare Provider Details

I. General information

NPI: 1841062452
Provider Name (Legal Business Name): ALEXA BENITEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5432 CARPINTERIA AVE
CARPINTERIA CA
93013-1423
US

IV. Provider business mailing address

4140 VIA REAL APT 28
CARPINTERIA CA
93013-1262
US

V. Phone/Fax

Practice location:
  • Phone: 805-566-0600
  • Fax:
Mailing address:
  • Phone: 805-280-8430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number52881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: