Provider Demographics
NPI:1033766084
Name:KANEAIAKALA, BENJAMIN K III (LAADC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:K
Last Name:KANEAIAKALA
Suffix:III
Gender:M
Credentials:LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PIARA ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1821
Mailing Address - Country:US
Mailing Address - Phone:949-463-8381
Mailing Address - Fax:
Practice Address - Street 1:18 PIARA ST
Practice Address - Street 2:
Practice Address - City:RANCHO MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92694-1821
Practice Address - Country:US
Practice Address - Phone:949-463-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI11840518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)