Individual
BENJAMIN WIDENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15342 HAWTHORNE BLVD, SUITE 102, LAWNDALE, CA 90260-2152
(310) 542-4825
Mailing address
16119 PRAIRIE AVE, LAWNDALE, CA 90260-2744
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
04/27/2009
Last updated
04/27/2009
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