Provider Demographics
NPI:1851413280
Name:MANA-AY, BENITA SABINA FLORES (MED)
Entity Type:Individual
Prefix:MRS
First Name:BENITA
Middle Name:SABINA FLORES
Last Name:MANA-AY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12515 MERIDIAN E
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3436
Mailing Address - Country:US
Mailing Address - Phone:253-848-2805
Mailing Address - Fax:253-435-5980
Practice Address - Street 1:12515 MERIDIAN E
Practice Address - Street 2:SUITE 204
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3436
Practice Address - Country:US
Practice Address - Phone:253-848-2805
Practice Address - Fax:253-435-5980
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health