Provider Demographics
NPI:1184102964
Name:BENAVIDES, KARLA MAIA MARIE QUIAZON (MA)
Entity type:Individual
Prefix:
First Name:KARLA MAIA MARIE
Middle Name:QUIAZON
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 COYOTE CIR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-1950
Mailing Address - Country:US
Mailing Address - Phone:209-637-0609
Mailing Address - Fax:
Practice Address - Street 1:3902 COYOTE CIR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:CA
Practice Address - Zip Code:94517-1950
Practice Address - Country:US
Practice Address - Phone:209-637-0609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health