Provider Demographics
NPI:1285383570
Name:JOSEPH, BENJAMIN BELARMINO
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:BELARMINO
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8925 SEPULVEDA BLVD STE 204D
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-4354
Mailing Address - Country:US
Mailing Address - Phone:818-322-8605
Mailing Address - Fax:818-647-6469
Practice Address - Street 1:8925 SEPULVEDA BLVD STE 204D
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-4354
Practice Address - Country:US
Practice Address - Phone:818-322-8605
Practice Address - Fax:818-647-6469
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550006739251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB21731Medicaid