Provider Demographics
NPI:1801956990
Name:BENENTI, JOSHUA A
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:A
Last Name:BENENTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 S EL CAJON CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGERVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:85938-5316
Mailing Address - Country:US
Mailing Address - Phone:928-551-7731
Mailing Address - Fax:
Practice Address - Street 1:428 S EL CAJON CIR
Practice Address - Street 2:
Practice Address - City:SPRINGERVILLE
Practice Address - State:AZ
Practice Address - Zip Code:85938-5316
Practice Address - Country:US
Practice Address - Phone:928-551-7731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No174400000XOther Service ProvidersSpecialist
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ882408OtherSTATE OF AZ