Provider Demographics
NPI:1194276790
Name:BENEDICTO, ROSALITA CRUZ (PHD)
Entity type:Individual
Prefix:DR
First Name:ROSALITA
Middle Name:CRUZ
Last Name:BENEDICTO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ROSY
Other - Middle Name:
Other - Last Name:BENEDICTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11901 SANTA MONICA BLVD # 703
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2767
Mailing Address - Country:US
Mailing Address - Phone:760-668-4079
Mailing Address - Fax:
Practice Address - Street 1:10921 WILSHIRE BLVD STE 901
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4000
Practice Address - Country:US
Practice Address - Phone:888-813-9613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28702103TC0700X
CAPSY 28702103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical