Healthcare Provider Details

I. General information

NPI: 1245141936
Provider Name (Legal Business Name): JONATHAN BENITEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 CAMFIELD AVE
COMMERCE CA
90040-1501
US

IV. Provider business mailing address

235 S WAYFIELD ST
ORANGE CA
92866-2317
US

V. Phone/Fax

Practice location:
  • Phone: 714-200-9896
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95469202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: