Provider Demographics
NPI:1275986812
Name:BENITEZ, CHRISTINE ANNE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANNE
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:ANNE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22159 E CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-4834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22159 E CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-4834
Practice Address - Country:US
Practice Address - Phone:480-567-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5747171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor