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General NPI Number Information
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NPI Number | 1225761042
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Entity Type | Individual
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Provider Name | MARISA ISABEL BENAVIDES SOLE
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Gender | Female
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 3782 W MARTIN LUTHER KING JR BLVD STE 330
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City | LOS ANGELES
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State | CA
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Zip | 90008-1703
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Country | US
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Telephone | 800-954-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1538 N MARTEL AVE APT 216
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City | LOS ANGELES
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State | CA
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Zip | 90046-8610
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Country | US
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Telephone | 916-613-8379
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY35445
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License Number State | CA
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