MEDICARE: DIAMOND MALIKA BENJAMIN INDEPENDENT PROVIDER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	374U00000X	Home Health Aide
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
3	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1174302251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIAMOND MALIKA BENJAMIN INDEPENDENT PROVIDER

Provider Business Mailing Address
First Line	:	2540 LOOP DR APT 236
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-1155
Country	:	US
Telephone Number	:	216-386-3049
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 LOOP DR APT 236
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-1155
Country	:	US
Telephone Number	:	216-386-3049
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	09/27/2023

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