Healthcare Provider Details

I. General information

NPI: 1689788044
Provider Name (Legal Business Name): BENJAMIN E LESIN ET AL PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14624 SHERMAN WAY SUITE 306
VAN NUYS CA
91405
US

IV. Provider business mailing address

14624 SHERMAN WAY SUITE 306
VAN NUYS CA
91405
US

V. Phone/Fax

Practice location:
  • Phone: 818-902-2880
  • Fax: 818-908-0536
Mailing address:
  • Phone: 818-902-2880
  • Fax: 818-908-0536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN E LESIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-902-2880