Healthcare Provider Details

I. General information

NPI: 1922614411
Provider Name (Legal Business Name): ALICE LEE A BENJAMIN ACNS-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2020
Last Update Date: 09/01/2024
Certification Date: 09/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11325 RIVERSIDE DR
TOLUCA LAKE CA
91602-1220
US

IV. Provider business mailing address

11333 MOORPARK ST # 30
STUDIO CITY CA
91602-2618
US

V. Phone/Fax

Practice location:
  • Phone: 619-252-8796
  • Fax:
Mailing address:
  • Phone: 619-813-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704326451
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTPAN2621
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF353226-01
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number3231
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016952
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: