Provider Demographics
NPI:1790391894
Name:BENITEZ, BLANCA ESTELA
Entity type:Individual
Prefix:MRS
First Name:BLANCA
Middle Name:ESTELA
Last Name:BENITEZ
Suffix:
Gender:
Credentials:
Other - Prefix:MISS
Other - First Name:BLANCA
Other - Middle Name:ESTELA
Other - Last Name:SOLORIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:658 E BRIER DR STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2875
Mailing Address - Country:US
Mailing Address - Phone:909-580-3705
Mailing Address - Fax:
Practice Address - Street 1:658 E BRIER DR STE 250
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2875
Practice Address - Country:US
Practice Address - Phone:909-838-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor