Active NPI
Benjamin M Wallman
- Marriage & Family Therapist
- Camarillo, CA
National Provider Identifier
1457535825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 148757
- Practice address
- 1722 S Lewis Rd
Camarillo, CA 93012-8520 - Phone
- (805) 766-8492
- Fax
- (805) 739-8863
- NPI assigned
- Dec 20, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 148757 | CA | Primary |
Addresses
Primary practice location
1722 S Lewis Rd
Camarillo, CA 93012-8520
Mailing address
PO Box 51
San Luis Obispo, CA 93406-0051
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 148757 | CA | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724371200000",
"number": "1457535825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 51",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934060051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1722 S LEWIS RD",
"city": "CAMARILLO",
"state": "CA",
"postal_code": "930128520",
"telephone_number": "805-766-8492",
"fax_number": "805-739-8863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLMAN",
"first_name": "BENJAMIN",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-20",
"last_updated": "2024-08-23",
"certification_date": "2024-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "148757",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camarillo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.