Basic Information
| Provider Information | |||||||||
| NPI: | 1598425407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENAVIDES | ||||||||
| FirstName: | SARAY | ||||||||
| MiddleName: | HERRERA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1968 W ADAMS BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900183515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237313534 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1968 W ADAMS BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900183515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237313534 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2021 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.