Healthcare Provider Details

I. General information

NPI: 1902139686
Provider Name (Legal Business Name): MR. BENJAMIN SAHAGUN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 E DEVONSHIRE AVE STE 201
HEMET CA
92543-3033
US

IV. Provider business mailing address

1011 E DEVONSHIRE AVE STE 201
HEMET CA
92543-3033
US

V. Phone/Fax

Practice location:
  • Phone: 909-816-8311
  • Fax:
Mailing address:
  • Phone: 909-599-1227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: