Provider Demographics
NPI:1003945809
Name:QUIRARTE, BENIGNO (MS)
Entity Type:Individual
Prefix:MR
First Name:BENIGNO
Middle Name:
Last Name:QUIRARTE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 TIMBRE
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2036
Mailing Address - Country:US
Mailing Address - Phone:949-468-9122
Mailing Address - Fax:
Practice Address - Street 1:23461 S POINTE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1547
Practice Address - Country:US
Practice Address - Phone:949-330-1672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist