Individual
BENJAMIN WEGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4760 SEPULVEDA BLVD, CULVER CITY, CA 90230-4820
(310) 390-6612
Mailing address
4760 SEPULVEDA BLVD, CULVER CITY, CA 90230-4820
(310) 390-6612
(310) 398-5690
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
33965
CA
225C00000X
Rehabilitation Counselor
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/21/2019
Last updated
06/28/2023
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