Healthcare Provider Details

I. General information

NPI: 1821567710
Provider Name (Legal Business Name): RAYMOND ANTHONY BENITEZ-TOLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 06/18/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 HAYES ST
SAN FRANCISCO CA
94117-1013
US

IV. Provider business mailing address

535 GEARY ST APT 408
SAN FRANCISCO CA
94102-1628
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5649
  • Fax:
Mailing address:
  • Phone: 650-773-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: