MEDICARE: JERRICA NADINE BENEDIX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1114428109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRICA NADINE BENEDIX

Provider Business Mailing Address
First Line	:	160 GLEN COVE MARINA RD E STE 102
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-7290
Country	:	US
Telephone Number	:	707-978-0347
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 GLEN COVE MARINA RD E STE 102
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-7290
Country	:	US
Telephone Number	:	707-978-0347
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2018
Last Update Date	:	08/14/2023

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Directions to “ JERRICA NADINE BENEDIX ” Practice Location

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