Healthcare Provider Details

I. General information

NPI: 1366839466
Provider Name (Legal Business Name): ERICA KJERSTEN BENSON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERICA BENSON DPM

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 04/23/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

IV. Provider business mailing address

1340 GRAND AVE
SAN RAFAEL CA
94901-2233
US

V. Phone/Fax

Practice location:
  • Phone: 325-370-5000
  • Fax:
Mailing address:
  • Phone: 415-250-7906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: