DR. DOMINIQUE BENAVIDEZ PH.D. - NPI 1740309525 - Psychologist in Long Beach, CA

Q: What is Dominique Benavidez's NPI number?

The NPI number for Dominique Benavidez is 1740309525. It was assigned to this individual provider in the NPPES registry on March 29, 2007.

Q: What is Dominique Benavidez's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Intellectual and Developmental Disabilities, with taxonomy code 103TM1800X.

On this page

About Dr. Dominique Benavidez Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DOMINIQUE BENAVIDEZ PH.D. (NPI 1740309525) is an individual intellectual and developmental disabilities provider in Long Beach, California, licensed in California (RPS2005098) and active in the NPI registry since March 2007. She is enrolled in Medicare PECOS, maintains a secondary practice location in Long Beach, and is a graduate of Other (2005).

NPPES Registry Identity

NPI1740309525

Entity TypeIndividualFemale

Primary Taxonomy103TM1800X

Provider Legal NameDR. DOMINIQUE BENAVIDEZCredential: PH.D.

Location Address335 REDONDO AVELong Beach, CA 90814

Mailing Address904 Silver Spur Rd # 297Rolling Hills Estates, CA 90274-3800 · (310) 373-0800 · Fax (310) 373-0868

Phone(562) 434-3030

Fax(562) 434-3212

Sole ProprietorYes

Medical School CMSOtherGraduated 2005

Enumeration DateMarch 29, 2007

Last NPPES UpdateJune 27, 2018

✔ NPI 1740309525 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyPsychologist · Intellectual and Developmental DisabilitiesBehavioral Health & Social Service Providers

Taxonomy Code103TM1800X

License✔ Licensed in CA · RPS2005098

Also ListedPsychologist · Adult Development & AgingTaxonomy 103TA0700X · License 22620 (CA)

Also ListedPsychologist · Cognitive & BehavioralTaxonomy 103TB0200X · License 22620 (CA)

Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License 22620 (CA)

Also ListedPsychologist · Clinical Child & AdolescentTaxonomy 103TC2200X · License 22620 (CA)

335 REDONDO AVE, Long Beach, CA 90814

Open in Google Maps ↗

Secondary Practice Location 1

Location 1335 Redondo AveLong Beach, CA 90814-2652 · Phone (562) 434-3030 · Fax (562) 434-3212

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Dominique Benavidez Ph.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4981756038

PECOS Enrollment IDI20090721000187

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHAYLA PATRON

Marriage & Family Therapist