Healthcare Provider Details

I. General information

NPI: 1225976707
Provider Name (Legal Business Name): JOSHUA RAYMOND BENITEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1274 CENTER COURT DRIVE SUITE 211 COVINA CA 91724.
COVINA CA
91724
US

IV. Provider business mailing address

1274 CENTER COURT DRIVE SUITE 211 COVINA CA 91724.
COVINA CA
91724
US

V. Phone/Fax

Practice location:
  • Phone: 626-339-4999
  • Fax: 626-339-4999
Mailing address:
  • Phone: 626-339-4999
  • Fax: 626-339-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberY9054104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: