Provider Demographics
NPI:1548976913
Name:BENACH, PEDRO LUIS
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:LUIS
Last Name:BENACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 MANOA RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3301
Mailing Address - Country:US
Mailing Address - Phone:808-376-9479
Mailing Address - Fax:
Practice Address - Street 1:1003 BISHOP ST STE 2700
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6475
Practice Address - Country:US
Practice Address - Phone:808-376-9479
Practice Address - Fax:888-375-4522
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0006047103TC0700X
HIPSY2075103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical