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General NPI Number Information
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NPI Number | 1760672679
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Entity Type | Individual
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Provider Name | BENJAMIN PHILIP COLEMAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 4025 CAMINO DEL RIO S STE 250
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City | SAN DIEGO
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State | CA
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Zip | 92108-4100
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Country | US
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Telephone | 619-858-3101
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Fax |
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Provider Business Mailing Address
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Address Line | 12625 HIGH BLUFF DR #104
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City | SAN DIEGO
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State | CA
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Zip | 92130-2052
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 27491
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License Number State | CA
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