Healthcare Provider Details

I. General information

NPI: 1457037970
Provider Name (Legal Business Name): MR. ANTHONY ANGEL BENITEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 NORMAL ST
SAN DIEGO CA
92103-2653
US

IV. Provider business mailing address

4100 NORMAL ST
SAN DIEGO CA
92103-2653
US

V. Phone/Fax

Practice location:
  • Phone: 619-725-8000
  • Fax:
Mailing address:
  • Phone: 619-725-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number8B03441826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: