Provider Demographics
NPI:1689476178
Name:TERENCE, BENEDICT
Entity type:Individual
Prefix:
First Name:BENEDICT
Middle Name:
Last Name:TERENCE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-1144
Mailing Address - Country:US
Mailing Address - Phone:626-782-8315
Mailing Address - Fax:
Practice Address - Street 1:1541 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-1144
Practice Address - Country:US
Practice Address - Phone:626-782-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95322355163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine