Healthcare Provider Details

I. General information

NPI: 1386246585
Provider Name (Legal Business Name): CRISTINA BENITEZ ALLEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S HUDSON AVE
PASADENA CA
91101-2910
US

IV. Provider business mailing address

12631 MENLO AVE APT 1
HAWTHORNE CA
90250-4594
US

V. Phone/Fax

Practice location:
  • Phone: 213-545-6745
  • Fax:
Mailing address:
  • Phone: 213-545-6745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number122778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: