Provider Demographics
NPI:1427779404
Name:BENITEZ-SANTIAGO, JAANAI (HS)
Entity type:Individual
Prefix:
First Name:JAANAI
Middle Name:
Last Name:BENITEZ-SANTIAGO
Suffix:
Gender:F
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CENTERPOINTE DR.,
Mailing Address - Street 2:SUITE 700
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623
Mailing Address - Country:US
Mailing Address - Phone:760-844-8355
Mailing Address - Fax:
Practice Address - Street 1:6 CENTERPOINTE DR.,
Practice Address - Street 2:SUITE 700
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623
Practice Address - Country:US
Practice Address - Phone:760-844-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY4893472Medicaid