Provider Demographics
NPI:1922614411
Name:BENJAMIN, ALICE LEE A (ACNS-BC, FNP-B)
Entity Type:Individual
Prefix:
First Name:ALICE LEE
Middle Name:A
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:ACNS-BC, FNP-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11333 MOORPARK ST # 30
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2618
Mailing Address - Country:US
Mailing Address - Phone:619-813-8905
Mailing Address - Fax:
Practice Address - Street 1:11325 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-1220
Practice Address - Country:US
Practice Address - Phone:619-252-8796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-20
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704326451363L00000X
CA3231364S00000X
CA95016952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist