Healthcare Provider Details

I. General information

NPI: 1013224369
Provider Name (Legal Business Name): BENJAMIN D SIMPSON P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3567 W. MT. WHITNEY AVE.
RIVERDALE CA
93656
US

IV. Provider business mailing address

PO BOX 543
RIVERDALE CA
93656-0543
US

V. Phone/Fax

Practice location:
  • Phone: 559-867-4416
  • Fax: 559-867-3010
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: