Provider Information for 1316646060
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BENJAMIN ALLAN MAXSON AMFT
Sex: Male
NPI: 1316646060
Last Updated: 2023-03-02
Certification Date: 2023-03-02
Certification Date: 2023-03-02
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1316646060 | ||||||||
| Enumeration Date | 2023-03-01 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 34232 PACIFIC COAST HWY STE D DANA POINT, CA 92629-3856 United States Phone: 949-304-3404 | Fax: | ||||||||
| Primary Practice Address | 34232 PACIFIC COAST HWY STE D DANA POINT, CA 92629-3856 United States Phone: 949-304-3404 | Fax: | ||||||||
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