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General NPI Number Information
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NPI Number | 1851645741
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Entity Type | Individual
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Provider Name | SUSAN EMILY BENEDICT
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Gender | Female
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Dates
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Enumeration Date | 10/31/2012
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Last Update Date | 10/31/2012
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Provider Practice Location Address
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Address Line | 133 S HUDSON AVE SUITE 4
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City | PASADENA
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State | CA
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Zip | 91101-2614
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Country | US
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Telephone | 626-398-1394
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Fax | 626-449-5515
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Provider Business Mailing Address
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Address Line | 133 S HUDSON AVE SUITE 4
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City | PASADENA
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State | CA
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Zip | 91101-2614
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Country | US
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Telephone | 626-398-1394
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Fax | 626-449-5515
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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 | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 20510
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License Number State | CA
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