Healthcare Provider Details

I. General information

NPI: 1659201044
Provider Name (Legal Business Name): GLORY BENZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1582 W SAN MARCOS BLVD STE 301
SAN MARCOS CA
92078-4081
US

IV. Provider business mailing address

30585 N GATE LN
MURRIETA CA
92563-2579
US

V. Phone/Fax

Practice location:
  • Phone: 951-587-6973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: