Provider Demographics
NPI:1316712086
Name:BENCH, JONATHAN (LAC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:BENCH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:CA
Mailing Address - Zip Code:93268-2632
Mailing Address - Country:US
Mailing Address - Phone:661-303-3362
Mailing Address - Fax:
Practice Address - Street 1:15 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-2632
Practice Address - Country:US
Practice Address - Phone:661-303-3362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19777171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist