Provider Demographics
NPI:1326629395
Name:BENJI, ATOOSA (LM)
Entity Type:Individual
Prefix:
First Name:ATOOSA
Middle Name:
Last Name:BENJI
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 N OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3530
Mailing Address - Country:US
Mailing Address - Phone:310-283-1434
Mailing Address - Fax:
Practice Address - Street 1:11870 SANTA MONICA BLVD STE 106-426
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2276
Practice Address - Country:US
Practice Address - Phone:310-283-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LM626176B00000X
CALM626176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife