Healthcare Provider Details

I. General information

NPI: 1124156591
Provider Name (Legal Business Name): CHRISTOPHER THOMAS BENITEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

887 POTRERO AVE
SAN FRANCISCO CA
94110
US

V. Phone/Fax

Practice location:
  • Phone: 213-605-4524
  • Fax:
Mailing address:
  • Phone: 415-206-6300
  • Fax: 415-206-6918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA88540
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA88540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: