MEDICARE: BENJAMIN PESSAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	4893810001	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4893810001	OTHER	ND	DME MEDICARE

General Provider Information

NPI Number	:	1104019843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENJAMIN PESSAH

Provider Business Mailing Address
First Line	:	1729 PALM AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-1150
Country	:	US
Telephone Number	:	619-575-1020
Fax Number	:	619-434-3449

Provider Business Practice Location Address
First Line	:	1729 PALM AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-1150
Country	:	US
Telephone Number	:	619-575-1020
Fax Number	:	619-343-3449

Authorized Official
Title or Position	:	SUPPLIER
Name	:	DR. BENJAMIN PESSAH
Credential	:	D.P.M.
Telephone Number	:	619-575-1020

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	08/27/2007

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Directions to “BENJAMIN PESSAH ” Practice Location

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