Provider Demographics
NPI:1336162148
Name:MEISEL, BENJAMIN HARRIS (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:HARRIS
Last Name:MEISEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:HARRIS
Other - Last Name:MEISEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:27506 BERKSHIRE HILLS PL
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1829
Mailing Address - Country:US
Mailing Address - Phone:661-284-5969
Mailing Address - Fax:661-284-5969
Practice Address - Street 1:27506 BERKSHIRE HILLS PL
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-1829
Practice Address - Country:US
Practice Address - Phone:661-284-5969
Practice Address - Fax:661-284-5969
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78935208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA78935OtherMED LICENSE
CA00A789350Medicaid
H85868Medicare UPIN