Healthcare Provider Details

I. General information

NPI: 1346247335
Provider Name (Legal Business Name): BEN SHWACHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N 3RD AVE SUITE 200
COVINA CA
91723-1905
US

IV. Provider business mailing address

315 N 3RD AVE SUITE 200
COVINA CA
91723-1905
US

V. Phone/Fax

Practice location:
  • Phone: 626-967-3176
  • Fax: 626-967-8743
Mailing address:
  • Phone: 626-967-3176
  • Fax: 626-967-8743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG11026
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberG11026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: