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General NPI Number Information
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NPI Number | 1609118165
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Entity Type | Organization
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Legal Business Name | DOMINIQUE BENAVIDEZ PSYCHOLOGY CONSULTANT AND ASSOCIATES
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Dates
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Enumeration Date | 03/22/2013
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Last Update Date | 03/22/2013
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Provider Practice Location Address
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Address Line | 24520 HAWTHORNE BLVD STE. 216
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City | TORRANCE
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State | CA
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Zip | 90505-6800
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Country | US
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Telephone | 310-373-0800
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Fax | 310-373-0880
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Provider Business Mailing Address
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Address Line | 904 SILVER SPUR RD #297
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City | ROLLING HILLS ESTATES
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State | CA
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Zip | 90274-3800
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Country | US
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Telephone | 310-373-0800
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Fax | 310-373-0880
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Authorized Official
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Title or Position | OWNER
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Name | DOMINIQUE BENAVIDEZ
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Credential | PHD
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Telephone | 310-373-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY22620
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License Number State | CA
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