Individual
JAMES BENJAMIN BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18646 OXNARD ST, TARZANA, CA 91356-1411
(818) 996-1051
Mailing address
10982 TOPEKA DR, NORTHRIDGE, CA 91326-2322
(818) 261-2456
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Enumeration date
02/07/2018
Last updated
02/07/2018
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