Provider Demographics
NPI:1750410676
Name:BENN, REGINALD LEWIS (CM)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:LEWIS
Last Name:BENN
Suffix:
Gender:M
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 E MENDOCINO ST
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2339
Mailing Address - Country:US
Mailing Address - Phone:626-794-5104
Mailing Address - Fax:
Practice Address - Street 1:855 N ORANGE GROVE BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3333
Practice Address - Country:US
Practice Address - Phone:626-796-3453
Practice Address - Fax:626-744-3411
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator