Provider Demographics
NPI:1124996020
Name:BENDER, BEN
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:BENDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12780 VENICE BLVD APT 9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3722
Mailing Address - Country:US
Mailing Address - Phone:937-765-6086
Mailing Address - Fax:
Practice Address - Street 1:742 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5543
Practice Address - Country:US
Practice Address - Phone:310-881-9045
Practice Address - Fax:888-298-5303
Is Sole Proprietor?:No
Enumeration Date:2025-10-23
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator