Healthcare Provider Details

I. General information

NPI: 1316856396
Provider Name (Legal Business Name): CRYSTAL BENAVIDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SUNSET AVE STE 270
SUISUN CITY CA
94585-2068
US

IV. Provider business mailing address

1100 FARMINGTON DR APT 156
VACAVILLE CA
95687-6792
US

V. Phone/Fax

Practice location:
  • Phone: 707-803-5007
  • Fax: 707-402-6702
Mailing address:
  • Phone: 951-531-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: