Provider Demographics
NPI:1366839466
Name:BENSON, ERICA KJERSTEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:KJERSTEN
Last Name:BENSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1340 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2233
Mailing Address - Country:US
Mailing Address - Phone:415-250-7906
Mailing Address - Fax:
Practice Address - Street 1:2500 ALHAMBRA AVE
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-3156
Practice Address - Country:US
Practice Address - Phone:325-370-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5462213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery