Provider Demographics
NPI:1225408412
Name:BENJAMIN, RAMAN
Entity Type:Individual
Prefix:
First Name:RAMAN
Middle Name:
Last Name:BENJAMIN
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 1:2800 WIND RIVER CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9383
Mailing Address - Country:US
Mailing Address - Phone:209-402-1925
Mailing Address - Fax:209-545-8485
Practice Address - Street 1:2800 WIND RIVER CT
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9383
Practice Address - Country:US
Practice Address - Phone:209-402-1925
Practice Address - Fax:209-545-8485
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program