Provider Demographics
NPI:1801944814
Name:BENITEZ, AARON BENJAMIN (RDHAP)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:BENJAMIN
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21001 COVELLO ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1403
Mailing Address - Country:US
Mailing Address - Phone:818-825-1389
Mailing Address - Fax:323-443-3904
Practice Address - Street 1:21001 COVELLO ST
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1403
Practice Address - Country:US
Practice Address - Phone:818-825-1389
Practice Address - Fax:323-443-3904
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA173124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZ89783-01Medicaid