Healthcare Provider Details

I. General information

NPI: 1437631405
Provider Name (Legal Business Name): CLORINDA GLORIA BENAVIDEZ RRT/SDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 KELLOGG AVE
CORONA CA
92879-3111
US

IV. Provider business mailing address

5853 RIDGEGATE DR
CHINO HILLS CA
91709-3257
US

V. Phone/Fax

Practice location:
  • Phone: 951-898-7480
  • Fax: 951-898-7320
Mailing address:
  • Phone: 909-393-0313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: