Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 20A15422 | CA |
NPI | 1740526748 |
---|---|
Provider Name | Dr. Benjamin Stanley Roberts |
First Address | Murrieta, CA 92562 |
Second Address | Murrieta, CA 92562-5989 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2012 |
Last Update Date | 17/03/2018 |