Healthcare Provider Details

I. General information

NPI: 1346963303
Provider Name (Legal Business Name): STANISLAVA MONIKA BENESOVSKY RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 08/01/2023
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 AVENUE F
REDONDO BEACH CA
90277-5008
US

IV. Provider business mailing address

212 AVENUE F
REDONDO BEACH CA
90277-5008
US

V. Phone/Fax

Practice location:
  • Phone: 310-755-4665
  • Fax:
Mailing address:
  • Phone: 310-755-4665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023075
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95066198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: