Provider Demographics
NPI:1558383059
Name:BENJAMIN, ASHLEY BEZALEEL (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BEZALEEL
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E DAILY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5838
Mailing Address - Country:US
Mailing Address - Phone:805-485-5051
Mailing Address - Fax:805-278-7945
Practice Address - Street 1:801 N AIR DEPOT BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110
Practice Address - Country:US
Practice Address - Phone:405-736-1500
Practice Address - Fax:405-736-1503
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK210872084P0800X
CAG882872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100193910AMedicaid