Provider Demographics
NPI:1639510654
Name:MICHAEL BENJMAIN, M.D., INC.
Entity Type:Organization
Organization Name:MICHAEL BENJMAIN, M.D., INC.
Other - Org Name:REGATTA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-517-4804
Mailing Address - Street 1:7325 MEDICAL CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1928
Mailing Address - Country:US
Mailing Address - Phone:818-570-2134
Mailing Address - Fax:818-835-0485
Practice Address - Street 1:2950 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1232
Practice Address - Country:US
Practice Address - Phone:818-570-2134
Practice Address - Fax:818-835-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86460207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty