Individual
CELINA CONCEPCION BENAVIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
14677 MERRILL AVE, FONTANA, CA 92335
(951) 643-2340
Mailing address
233 W. BASELINE RD, BOX 400, LA VERNE, CA 91750
(909) 833-2986
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT36261
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPT36261
BVNPT
CA
Enumeration date
01/27/2016
Last updated
09/18/2019
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