Provider Demographics
NPI:1245461888
Name:YERUSHALMI, BENJAMIN (PA-C)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:YERUSHALMI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:MS#69
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-2142
Mailing Address - Fax:323-361-1310
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MS#69
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-2142
Practice Address - Fax:323-361-1310
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20744363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical