Individual
DEBRA MARIE BENEVIDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2811 COLD SPRINGS RD, PLACERVILLE, CA 95667-4044
(530) 621-6213
Mailing address
2811 COLD SPRINGS RD, PLACERVILLE, CA 95667-4044
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 36200
CA
Other
Enumeration date
09/19/2013
Last updated
09/19/2013
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