Healthcare Provider Details

I. General information

NPI: 1558383059
Provider Name (Legal Business Name): ASHLEY BEZALEEL BENJAMIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3836 KANAN RD
AGOURA HILLS CA
91301-3237
US

IV. Provider business mailing address

4935 VIA CAMINO
NEWBURY PARK CA
91320-6857
US

V. Phone/Fax

Practice location:
  • Phone: 818-532-7018
  • Fax: 818-688-0705
Mailing address:
  • Phone: 805-490-0343
  • Fax: 818-688-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG88287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: