Provider Demographics
NPI:1245783224
Name:JOSEPH, BEN
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:JOSEPH
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 1:21109 LAGO BELLO LN
Mailing Address - Street 2:
Mailing Address - City:FRIANT
Mailing Address - State:CA
Mailing Address - Zip Code:93626-1209
Mailing Address - Country:US
Mailing Address - Phone:559-326-0834
Mailing Address - Fax:559-675-5224
Practice Address - Street 1:21109 LAGO BELLO LN
Practice Address - Street 2:
Practice Address - City:FRIANT
Practice Address - State:CA
Practice Address - Zip Code:93626-1209
Practice Address - Country:US
Practice Address - Phone:559-326-0834
Practice Address - Fax:559-675-5224
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine