Healthcare Provider Details

I. General information

NPI: 1154697100
Provider Name (Legal Business Name): BENJAMIN ASHER FARBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 08/17/2024
Certification Date: 08/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92350-1716
US

IV. Provider business mailing address

11370 ANDERSON STREET FMC-2100
LOMA LINDA CA
92354
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4619
  • Fax:
Mailing address:
  • Phone: 909-558-5939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberA198217
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-46096
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number281893
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD-46096
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number281893
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: