Provider Demographics
NPI:1851750624
Name:BENJAMIN, VERONICA ALYSE (MPH,RD)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:ALYSE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MPH,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 SAINT AUGUSTINE WAY
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-4623
Mailing Address - Country:US
Mailing Address - Phone:707-778-8260
Mailing Address - Fax:707-778-7537
Practice Address - Street 1:320 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2919
Practice Address - Country:US
Practice Address - Phone:707-765-8891
Practice Address - Fax:707-778-7537
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered