Provider Demographics
NPI:1003064718
Name:THEM, BENJAMIN (RN)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:THEM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10002 SAN JUAN ST
Mailing Address - Street 2:#4
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1635
Mailing Address - Country:US
Mailing Address - Phone:619-346-5854
Mailing Address - Fax:
Practice Address - Street 1:10002 SAN JUAN ST
Practice Address - Street 2:APT 4
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1635
Practice Address - Country:US
Practice Address - Phone:619-346-5854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician