Provider Demographics
NPI:1891055091
Name:LESHIN, BENJAMIN A (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:A
Last Name:LESHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10565 CIVIC CENTER DR STE 250
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3854
Mailing Address - Country:US
Mailing Address - Phone:909-493-3800
Mailing Address - Fax:
Practice Address - Street 1:1127 WILSHIRE BLVD STE 800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3909
Practice Address - Country:US
Practice Address - Phone:213-839-1119
Practice Address - Fax:213-839-1120
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA142191208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA142191OtherCA LIC #A142191