Provider Demographics
NPI:1205924503
Name:BENBOW, CHRISTOPHER H (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:H
Last Name:BENBOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:STE 910
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-622-0590
Mailing Address - Fax:858-558-0250
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:STE 910
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-622-0590
Practice Address - Fax:858-558-0250
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA480162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A48016OtherBLUE SHIELD OF CA
CA060132OtherMHN
CA060132OtherMHN
E99884Medicare UPIN