Provider Demographics
NPI:1821567710
Name:BENITEZ-TOLER, RAYMOND ANTHONY
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ANTHONY
Last Name:BENITEZ-TOLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 GEARY ST APT 408
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1628
Mailing Address - Country:US
Mailing Address - Phone:650-773-0496
Mailing Address - Fax:
Practice Address - Street 1:2200 HAYES ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1013
Practice Address - Country:US
Practice Address - Phone:415-750-5649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other