Individual
DR. BEN J. CHILDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4605 BROCKTON AVE, SUITE 200, RIVERSIDE, CA 92506-0106
(951) 781-4366
(951) 274-0985
Mailing address
4605 BROCKTON AVE, SUITE 200, RIVERSIDE, CA 92506-0106
(951) 781-4366
(951) 274-0985
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G76953
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200975173
TAX ID
CA
Enumeration date
11/01/2006
Last updated
07/08/2007
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