Provider Demographics
NPI:1104374883
Name:FRIMMER, BENJAMIN ROSS (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ROSS
Last Name:FRIMMER
Suffix:
Gender:M
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6269
Mailing Address - Country:US
Mailing Address - Phone:215-920-4236
Mailing Address - Fax:
Practice Address - Street 1:2719 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6269
Practice Address - Country:US
Practice Address - Phone:215-920-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53749363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant