Individual
BENJAMIN ZEQUEIRA-RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
140 E COLORADO BLVD STE D, MONROVIA, CA 91016-5145
(626) 358-1564
Mailing address
140 E COLORADO BLVD STE D, MONROVIA, CA 91016-5145
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY19727
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407114986
TYPE 2 NPI- REAL CONNECTIONS CHILD DEVELOPMENT INSTITUTE
CA
Enumeration date
04/27/2016
Last updated
04/27/2016
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