Provider Demographics
NPI:1699429621
Name:BENITEZ, MARISOL
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26357 MCBEAN PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4497
Mailing Address - Country:US
Mailing Address - Phone:661-593-7349
Mailing Address - Fax:661-568-6856
Practice Address - Street 1:26357 MCBEAN PKWY STE 210
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-4497
Practice Address - Country:US
Practice Address - Phone:661-593-7349
Practice Address - Fax:661-568-6856
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016050363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner