Healthcare Provider Details

I. General information

NPI: 1699600098
Provider Name (Legal Business Name): ERIC BENNION CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 CLEAVELAND RD UNIT 228
PLEASANT HILL CA
94523-3716
US

IV. Provider business mailing address

85 CLEAVELAND RD UNIT 228
PLEASANT HILL CA
94523-3716
US

V. Phone/Fax

Practice location:
  • Phone: 925-324-8406
  • Fax:
Mailing address:
  • Phone: 925-324-8406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number259214
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: