Provider Demographics
NPI:1912641739
Name:BENITEZ-DANAO, HERLI MIJARES (PT)
Entity Type:Individual
Prefix:
First Name:HERLI
Middle Name:MIJARES
Last Name:BENITEZ-DANAO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19845 LAKE CHABOT RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4055
Mailing Address - Country:US
Mailing Address - Phone:510-200-9959
Mailing Address - Fax:888-251-2818
Practice Address - Street 1:19845 LAKE CHABOT RD STE 102
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4055
Practice Address - Country:US
Practice Address - Phone:510-200-9959
Practice Address - Fax:888-251-2818
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty