Provider Demographics
NPI:1851557516
Name:BENITEZ, CHERYL MOANA MARIE (BA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:MOANA MARIE
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22991 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7914
Mailing Address - Country:US
Mailing Address - Phone:951-609-0155
Mailing Address - Fax:
Practice Address - Street 1:41870 KALMIA ST
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8839
Practice Address - Country:US
Practice Address - Phone:951-696-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101Y00000XOtherBEHAVIOR COACH