Provider Demographics
NPI:1790419299
Name:BENABOU, TEHILLA SOLAMIT
Entity Type:Individual
Prefix:
First Name:TEHILLA
Middle Name:SOLAMIT
Last Name:BENABOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9947 YOUNG DR APT 9947 1/2
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3629
Mailing Address - Country:US
Mailing Address - Phone:310-756-5119
Mailing Address - Fax:
Practice Address - Street 1:9947 YOUNG DR APT 9947 1/2
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3629
Practice Address - Country:US
Practice Address - Phone:310-756-5119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical