Healthcare Provider Details

I. General information

NPI: 1265554851
Provider Name (Legal Business Name): ANA E BENAVENTE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 E HOLT AVE
POMONA CA
91767-5822
US

IV. Provider business mailing address

7080 HOLLYWOOD BLVD STE 815
LOS ANGELES CA
90028-6935
US

V. Phone/Fax

Practice location:
  • Phone: 909-630-7927
  • Fax: 909-620-6719
Mailing address:
  • Phone: 510-345-4379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number116853
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number54606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: