Healthcare Provider Details

I. General information

NPI: 1669320792
Provider Name (Legal Business Name): NAYELI ABIGAIL BENITEZ SAN JUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S OLIVE ST STE 1200
LOS ANGELES CA
90015-2211
US

IV. Provider business mailing address

1150 S OLIVE ST STE 1200
LOS ANGELES CA
90015-2211
US

V. Phone/Fax

Practice location:
  • Phone: 323-535-3270
  • Fax:
Mailing address:
  • Phone: 323-535-3270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberD5787780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: