Provider Demographics
NPI:1003637828
Name:MARTE, BENJAMIN (RN)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:MARTE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12815 DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-6055
Mailing Address - Country:US
Mailing Address - Phone:858-472-3851
Mailing Address - Fax:
Practice Address - Street 1:12815 DAKOTA ST
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-6055
Practice Address - Country:US
Practice Address - Phone:858-472-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN953497163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health