Provider Demographics
NPI:1336621176
Name:PIERCE, BENJAMIN ALLAN
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALLAN
Last Name:PIERCE
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 1:2155 W MARCH LN STE 2F
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6420
Mailing Address - Country:US
Mailing Address - Phone:209-910-4644
Mailing Address - Fax:209-956-9180
Practice Address - Street 1:2155 W MARCH LN STE 2F
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6420
Practice Address - Country:US
Practice Address - Phone:209-910-4644
Practice Address - Fax:209-956-9180
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)