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General NPI Number Information
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NPI Number | 1770037632
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Entity Type | Individual
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Provider Name | BENJAMIN METTA PENHAS PSYD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 9666 BUSINESSPARK AVE
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City | SAN DIEGO
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State | CA
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Zip | 92131-1646
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Country | US
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Telephone | 619-600-0073
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Fax |
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Provider Business Mailing Address
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Address Line | 4745 W PARK BLVD STE113-1058
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City | PLANO
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State | TX
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Zip | 75093-2329
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 32888
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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