Most Relevant Information
Provider Data
| NPI Number: | 1003273558 |
| Provider Name: | CELINA CONCEPCION BENAVIDES LPT |
| Entity Type: | Individual |
| Taxonomy Code: | 167G00000X |
| Specialty: | Licensed Psychiatric Technician |
| License Number: | PT36261 |
Most Important Dates
| Enumeration Date: | 01/27/2016 |
| Last Updated: | 09/18/2019 |
Provider Practice Location
14677 MERRILL AVE
FONTANA
CA
92335
Practice Location Phone/Fax
| Phone: | 9516432340 |
| Fax: |
Provider Mailing Location
233 W. BASELINE RD
BOX 400
LA VERNE
CA
91750
Provider Mailing Phone/Fax
| Phone: | 9098332986 |
| Fax: |