Healthcare Provider Details

I. General information

NPI: 1649391897
Provider Name (Legal Business Name): BENJAMIN DAVID TARBUTTON B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PACIFICA AVENUE
BAY POINT CA
94565-2904
US

IV. Provider business mailing address

205 PACIFICA AVENUE
BAY POINT CA
94565-2901
US

V. Phone/Fax

Practice location:
  • Phone: 925-458-3216
  • Fax: 925-458-7623
Mailing address:
  • Phone: 925-458-3216
  • Fax: 925-458-7623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: