Provider Demographics
NPI:1396241915
Name:BENIN, SAMANTHA (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:BENIN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 S MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2536
Mailing Address - Country:US
Mailing Address - Phone:951-734-4880
Mailing Address - Fax:951-734-7963
Practice Address - Street 1:2250 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2536
Practice Address - Country:US
Practice Address - Phone:951-734-4880
Practice Address - Fax:951-734-7963
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA173499207RC0000X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease