Active NPI
Jacqueline A Benjamin, M.D.
- Neuropathology Physician
- Los Angeles, CA
National Provider Identifier
1699091702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neuropathology Physician
- License
- A77777
- Practice address
- 1500 San Pablo St
Los Angeles, CA 90033-5313 - Phone
- (323) 442-9621
- NPI assigned
- Apr 14, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Forensic Pathology Physician | 207ZF0201X | 12173 | NV | |
| Neuropathology Physician | 207ZN0500X | A77777 | CA | Primary |
Addresses
Primary practice location
1500 San Pablo St
Los Angeles, CA 90033-5313
Mailing address
1500 San Pablo St
Los Angeles, CA 90033-5313
Phone (323) 442-9621
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12173 | NV | MD | Forensic Pathology Physician |
| A77777 | CA | MD | Neuropathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314057600000",
"number": "1699091702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 SAN PABLO ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900335313",
"telephone_number": "323-442-9621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 SAN PABLO ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900335313",
"telephone_number": "323-442-9621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENJAMIN",
"first_name": "JACQUELINE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-04-14",
"last_updated": "2011-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "207ZF0201X",
"taxonomy_group": "",
"desc": "Pathology, Forensic Pathology",
"state": "NV",
"license": "12173",
"primary": false
},
{
"code": "207ZN0500X",
"taxonomy_group": "",
"desc": "Pathology, Neuropathology",
"state": "CA",
"license": "A77777",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.