Provider Demographics
NPI:1881222503
Name:BENJAMIN, COREY ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:ANTONIO
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W ARBOR DR # MC8770
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1911
Mailing Address - Country:US
Mailing Address - Phone:619-543-5297
Mailing Address - Fax:619-543-6162
Practice Address - Street 1:200 W ARBOR DR # MC8770
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1911
Practice Address - Country:US
Practice Address - Phone:619-543-5297
Practice Address - Fax:619-543-6162
Is Sole Proprietor?:No
Enumeration Date:2020-03-29
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program