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General NPI Number Information
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NPI Number | 1093571135
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Entity Type | Individual
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Provider Name | BENJAMIN EVAN BRISTOL DPT
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Gender | Male
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 15302 EL PRADO RD
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City | CHINO
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State | CA
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Zip | 91710-7659
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Country | US
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Telephone | 909-393-7222
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 CHINO HILLS PKWY UNIT 222
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City | CHINO HILLS
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State | CA
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Zip | 91709-4232
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Country | US
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Telephone | 661-304-5277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 305541
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License Number State | CA
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