Provider Demographics
NPI:1689300352
Name:SAMONTE, BEN
Entity Type:Individual
Prefix:MR
First Name:BEN
Middle Name:
Last Name:SAMONTE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BEN
Other - Middle Name:DUMANDAN
Other - Last Name:SAMONTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:723 EASTSHORE TER UNIT 57
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2418
Mailing Address - Country:US
Mailing Address - Phone:619-274-4984
Mailing Address - Fax:
Practice Address - Street 1:5520 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1206
Practice Address - Country:US
Practice Address - Phone:858-694-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95248450163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20131241OtherKAISER