Healthcare Provider Details

I. General information

NPI: 1720959406
Provider Name (Legal Business Name): MRS. TYRELL KNOX-BENJAMIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 57TH ST STE 530
SACRAMENTO CA
95819-3327
US

IV. Provider business mailing address

836 57TH ST STE 530
SACRAMENTO CA
95819-3327
US

V. Phone/Fax

Practice location:
  • Phone: 916-800-8108
  • Fax:
Mailing address:
  • Phone: 916-800-8108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: