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General NPI Number Information
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NPI Number | 1558499160
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Entity Type | Individual
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Provider Name | MATTHEW BRYAN BENN
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Gender | Male
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 201 FRONT ST
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City | SANTA CRUZ
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State | CA
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Zip | 95060-4544
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Country | US
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Telephone | 831-421-9142
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Fax | 831-421-9392
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Provider Business Mailing Address
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Address Line | 276 SUN RIDGE LN
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City | SAN JOSE
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State | CA
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Zip | 95123-6505
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Country | US
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Telephone | 831-476-4806
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 70170
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License Number State | CA
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