Healthcare Provider Details

I. General information

NPI: 1366933186
Provider Name (Legal Business Name): BENJAMIN ABNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE
OCEANSIDE CA
92055
US

IV. Provider business mailing address

305 E AVENIDA SAN JUAN
SAN CLEMENTE CA
92672-2327
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1577
  • Fax:
Mailing address:
  • Phone: 609-321-3503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMD477895
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD477895
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: