Individual
DR. DOMINIQUE BENAVIDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
335 REDONDO AVE, LONG BEACH, CA 90814
(562) 434-3030
(562) 434-3212
Mailing address
904 SILVER SPUR RD # 297, ROLLING HILLS ESTATES, CA 90274-3800
(310) 373-0800
(310) 373-0868
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
22620
CA
103TB0200X
Cognitive & Behavioral Psychologist
22620
CA
103TC0700X
Clinical Psychologist
22620
CA
103TC2200X
Clinical Child & Adolescent Psychologist
22620
CA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
RPS2005098
CA
Other
Enumeration date
03/29/2007
Last updated
06/27/2018
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