=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104374883
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENJAMIN ROSS FRIMMER MS, PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2016
-----------------------------------------------------
Last Update Date | 07/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 777 E FOOTHILL BLVD
-----------------------------------------------------
City | SAN LUIS OBISPO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93405-1617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-762-4348
-----------------------------------------------------
Fax | 805-541-1167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2719 3RD AVE
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92103-6269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-920-4236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 53749
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------