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General NPI Number Information
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NPI Number | 1407710726
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Entity Type | Individual
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Provider Name | BENJAMIN SO RBT
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Gender | Male
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Dates
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Enumeration Date | 12/11/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 2820 CAMINO DEL RIO S STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92108-3822
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Country | US
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Telephone | 800-434-8923
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Fax | 858-649-6012
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Provider Business Mailing Address
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Address Line | 5180 DE BURN DR
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City | SAN DIEGO
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State | CA
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Zip | 92105-5411
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Country | US
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Telephone | 619-808-9829
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-380229
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License Number State | CA
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