Provider Demographics
NPI:1700044187
Name:BENITEZ, MARIA TERESA DATAN (MD)
Entity Type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:DATAN
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N PALM CANYON DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4414
Mailing Address - Country:US
Mailing Address - Phone:760-327-7900
Mailing Address - Fax:760-327-7905
Practice Address - Street 1:1100 N PALM CANYON DR
Practice Address - Street 2:SUITE 212
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4414
Practice Address - Country:US
Practice Address - Phone:760-327-7900
Practice Address - Fax:760-327-7905
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55826207V00000X
MI4301092193207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101242Medicaid
CAZZZ27958ZOtherMEDICARE GROUP ID
CAGR0101241Medicaid
CAGR0101240Medicaid
CAZZZ27958ZOtherMEDICARE GROUP ID
CACA117566Medicare UPIN
MI1700044187OtherMOLINA HEALTH PLAN OF MICHIGAN
MI0G36111-100Medicare PIN