Individual
BENJAMIN TETSU LISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 N ASHWOOD AVE, VENTURA, CA 93003-1810
(805) 658-5800
(805) 639-0786
Mailing address
5855 OLIVAS PARK DR, VENTURA, CA 93003-7672
(805) 667-2801
(805) 667-2865
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A67012
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050394
BLUE CROSS
CA
01
—
95-1683892
OTHER INSURANCE
CA
05
—
RHM08608F
—
CA
05
—
RHM08609F
—
CA
05
—
RHM18553H
—
CA
05
—
ZZT40394F
—
CA
Enumeration date
05/19/2006
Last updated
12/26/2013
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