Provider Demographics
NPI:1588967749
Name:BENEJ PEDIATRICS INC.
Entity type:Organization
Organization Name:BENEJ PEDIATRICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINWE
Authorized Official - Middle Name:STELLA
Authorized Official - Last Name:OJUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-796-2400
Mailing Address - Street 1:11306 MOUNTAIN VIEW AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3832
Mailing Address - Country:US
Mailing Address - Phone:909-796-2400
Mailing Address - Fax:909-796-2443
Practice Address - Street 1:11306 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE E
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3832
Practice Address - Country:US
Practice Address - Phone:909-796-2400
Practice Address - Fax:909-796-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102676208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty