Individual
BENJAMIN RAY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1010 W LA VETA AVE STE 750, ORANGE, CA 92868-4312
(714) 639-9401
Mailing address
1010 W LA VETA AVE STE 750, ORANGE, CA 92868-4312
(714) 639-9401
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
52963
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912919804
TYPE 2 NPI
CA
01
—
52963
MEDICAL LICENSE
CA
01
—
GRP. NPI: 1912919804
MEDI-CAL
CA
Enumeration date
10/19/2015
Last updated
07/21/2022
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