Provider Demographics
NPI:1598223273
Name:USIADE, BENSON I
Entity Type:Individual
Prefix:MR
First Name:BENSON
Middle Name:I
Last Name:USIADE
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:BENSON USIADE
Mailing Address - Street 2:41125 BANK CT.
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-4009
Mailing Address - Country:US
Mailing Address - Phone:760-881-2382
Mailing Address - Fax:
Practice Address - Street 1:BENSON USIADE
Practice Address - Street 2:41125 BANK CT.
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-4009
Practice Address - Country:US
Practice Address - Phone:760-881-2382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty