Healthcare Provider Details

I. General information

NPI: 1558640573
Provider Name (Legal Business Name): HAZEL BENIGNO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11B SAN PEDRO RD
DALY CITY CA
94014-2527
US

IV. Provider business mailing address

11B SAN PEDRO RD
DALY CITY CA
94014-2527
US

V. Phone/Fax

Practice location:
  • Phone: 415-967-0815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY30054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: