| Randall Jay Benefield | |
|
921 Transport Way Petaluma CA 94954-1461 | |
| (707) 478-8697 | |
| Not Available |
| Full Name | Randall Jay Benefield |
|---|---|
| Speciality | Behavior Analyst |
| Location | 921 Transport Way, Petaluma, California |
| Authorized Official Name and Position | Randy Benefield (OWNER) |
| Authorized Official Contact | 7074788697 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Randall Jay Benefield 3188 Rocklin Dr Santa Rosa CA 95405-7035 Ph: (707) 478-8697 | Randall Jay Benefield 921 Transport Way Petaluma CA 94954-1461 Ph: (707) 478-8697 |
| NPI Number | 1790492304 |
|---|---|
| Provider Enumeration Date | 11/02/2022 |
| Last Update Date | 11/02/2022 |
| Certification Date | 11/02/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790492304 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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