Organization
DOMINIQUE BENAVIDEZ PSYCHOLOGY CONSULTANT AND ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE BENAVIDEZ PHD (OWNER)
(310) 373-0800
Entity
Organization
Contact information
Practice address
24520 HAWTHORNE BLVD, STE. 216, TORRANCE, CA 90505-6800
(310) 373-0800
(310) 373-0880
Mailing address
904 SILVER SPUR RD, #297, ROLLING HILLS ESTATES, CA 90274-3800
(310) 373-0800
(310) 373-0880
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY22620
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC615A
PTAN
CA
Enumeration date
03/22/2013
Last updated
03/22/2013
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