Provider Demographics
NPI:1790348324
Name:BENZ, TESSA REYES
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:REYES
Last Name:BENZ
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 1:2304 N CATALINA ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-3207
Mailing Address - Country:US
Mailing Address - Phone:615-554-0500
Mailing Address - Fax:
Practice Address - Street 1:2304 N CATALINA ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-3207
Practice Address - Country:US
Practice Address - Phone:615-554-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula