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General NPI Number Information
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NPI Number | 1144881442
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Entity Type | Individual
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Provider Name | MR. BENJAMIN GRIFFIN-MEDELLIN
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Gender | Male
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 03/23/2025
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Provider Practice Location Address
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Address Line | 502 W HIGHLAND BLVD
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City | INVERNESS
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State | FL
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Zip | 34452-4720
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Country | US
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Telephone | 352-726-1551
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 N 19TH AVE UNIT 108
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City | PHOENIX
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State | AZ
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Zip | 85015-6003
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Country | US
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Telephone | 508-241-2210
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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