Provider Demographics
NPI:1851557516
Name:BENITEZ, CHERYL MOANA MARIE (MA)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:MOANA MARIE
Last Name:BENITEZ
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:MOANA MARIE
Other - Last Name:BENITEZ MOLINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:35831 GLISSANT DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-9150
Mailing Address - Country:US
Mailing Address - Phone:951-514-1756
Mailing Address - Fax:
Practice Address - Street 1:35831 GLISSANT DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-9150
Practice Address - Country:US
Practice Address - Phone:519-514-1756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101Y00000XOtherBEHAVIOR COACH