Provider Demographics
NPI:1588004808
Name:BENITEZ, TINA (IBCLC, RLC)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 ARCHMONT PL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2228
Mailing Address - Country:US
Mailing Address - Phone:510-206-7080
Mailing Address - Fax:
Practice Address - Street 1:3917 ARCHMONT PL
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2228
Practice Address - Country:US
Practice Address - Phone:510-206-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN