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General NPI Number Information
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NPI Number | 1104019843
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Entity Type | Organization
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Legal Business Name | BENJAMIN PESSAH
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 08/27/2007
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Provider Practice Location Address
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Address Line | 1729 PALM AVE
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City | SAN DIEGO
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State | CA
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Zip | 92154-1150
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Country | US
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Telephone | 619-575-1020
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Fax | 619-343-3449
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Provider Business Mailing Address
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Address Line | 1729 PALM AVE
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City | SAN DIEGO
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State | CA
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Zip | 92154-1150
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Country | US
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Telephone | 619-575-1020
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Fax | 619-434-3449
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Authorized Official
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Title or Position | SUPPLIER
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Name | DR. BENJAMIN PESSAH
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Credential | D.P.M.
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Telephone | 619-575-1020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 4893810001
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License Number State | CA
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