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NPI Code Detail

MEDICARE: DOMINIQUE BENJAMIN RN, FNP

MEDICARE: DOMINIQUE BENJAMIN RN, FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse95044219CA
2363LF0000XFamily Nurse Practitioner95004365CA

General Provider Information

NPI Number : 1790220879
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIQUE BENJAMIN RN, FNP
Provider Business Mailing Address
First Line : 11795 W OLYMPIC BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-1211
Country : US
Telephone Number : 888-227-3312
Fax Number :
Provider Business Practice Location Address
First Line : 11795 W OLYMPIC BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-1211
Country : US
Telephone Number : 888-227-3312
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2016
Last Update Date : 07/07/2021

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