Healthcare Provider Details

I. General information

NPI: 1679123202
Provider Name (Legal Business Name): MEREDITH ATLAS BENZION LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23548 LYONS AVE STE B
NEWHALL CA
91321-5782
US

IV. Provider business mailing address

23528 HERITAGE OAK CT
NEWHALL CA
91321-3700
US

V. Phone/Fax

Practice location:
  • Phone: 661-254-3000
  • Fax:
Mailing address:
  • Phone: 661-388-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: