Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 39950 | CA |
NPI | 1730609199 |
---|---|
Provider Name | Dr. Benjamin Logan Terrano |
First Address | San Diego, CA 92108-1745 |
Second Address | San Diego, CA 92108-1745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2017 |
Last Update Date | 11/07/2019 |