Active NPI
Braddon Charles Benson, OTR/L
- Occupational Therapist
- Fontana, CA
National Provider Identifier
1972083608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 19019
- Practice address
- 9440 Citrus Ave
Fontana, CA 92335-5512 - Phone
- (909) 823-3481
- NPI assigned
- Aug 21, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 19019 | CA | Primary |
Addresses
Primary practice location
9440 Citrus Ave
Fontana, CA 92335-5512
Mailing address
9440 Citrus Ave
Fontana, CA 92335-5512
Phone (909) 823-3481
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 |
|---|---|---|---|
| 19019 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534809600000",
"number": "1972083608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9440 CITRUS AVE",
"city": "FONTANA",
"state": "CA",
"postal_code": "923355512",
"telephone_number": "909-823-3481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9440 CITRUS AVE",
"city": "FONTANA",
"state": "CA",
"postal_code": "923355512",
"telephone_number": "909-823-3481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENSON",
"first_name": "BRADDON",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-08-21",
"last_updated": "2018-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": "CA",
"license": "19019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fontana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.