Provider Demographics
NPI:1114565801
Name:BENSON, ADA MARIA P (HOME HEALTH CARE AID)
Entity Type:Individual
Prefix:MS
First Name:ADA MARIA
Middle Name:P
Last Name:BENSON
Suffix:
Gender:F
Credentials:HOME HEALTH CARE AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 S STATE ST UNIT 3054
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92546-7124
Mailing Address - Country:US
Mailing Address - Phone:951-599-9724
Mailing Address - Fax:
Practice Address - Street 1:235 S. LYON
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543
Practice Address - Country:US
Practice Address - Phone:951-599-9724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7517348466253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7517348466OtherIEHP