Provider Demographics
NPI:1790793040
Name:BENJAMIN, ALICIA COLLINS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:COLLINS
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FIR STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2327
Mailing Address - Country:US
Mailing Address - Phone:858-499-2600
Mailing Address - Fax:619-446-1569
Practice Address - Street 1:300 FIR STREET
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2327
Practice Address - Country:US
Practice Address - Phone:858-499-2600
Practice Address - Fax:619-446-1569
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G697210Medicaid
CAF11195Medicare UPIN
CA00G697210Medicaid