Provider Demographics
NPI:1558077263
Name:BENEDICKTUS, CYNTHIA JOANNE
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JOANNE
Last Name:BENEDICKTUS
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 1:13 HAWTHORN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2331
Mailing Address - Country:US
Mailing Address - Phone:310-803-7233
Mailing Address - Fax:
Practice Address - Street 1:13 HAWTHORN
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2331
Practice Address - Country:US
Practice Address - Phone:310-803-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA761324163WC0200X
CA95024136363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine