Provider Demographics
NPI:1386931665
Name:BENSON, ROSALYN T (NP)
Entity type:Individual
Prefix:
First Name:ROSALYN
Middle Name:T
Last Name:BENSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15078 CALLE DEL ORO
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5069
Mailing Address - Country:US
Mailing Address - Phone:909-606-9692
Mailing Address - Fax:
Practice Address - Street 1:15078 CALLE DEL ORO
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5069
Practice Address - Country:US
Practice Address - Phone:909-606-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507989163WS0200X
CA11707363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11707OtherNURSE PRACTITIONER
CA507989OtherREGISTERED NURSE