Provider Demographics
NPI:1225661358
Name:BEN-DAVID, ELYSHA
Entity Type:Individual
Prefix:
First Name:ELYSHA
Middle Name:
Last Name:BEN-DAVID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 OVERLAND AVE UNIT 232
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4277
Mailing Address - Country:US
Mailing Address - Phone:949-395-2510
Mailing Address - Fax:
Practice Address - Street 1:7120 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3618
Practice Address - Country:US
Practice Address - Phone:818-881-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist