Provider Demographics
NPI:1144016635
Name:HEALD, BENJAMIN JOHN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JOHN
Last Name:HEALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14291 RIOS CANYON RD SPC 30
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-2722
Mailing Address - Country:US
Mailing Address - Phone:858-945-7545
Mailing Address - Fax:
Practice Address - Street 1:14291 RIOS CANYON RD SPC 30
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-2722
Practice Address - Country:US
Practice Address - Phone:858-945-7545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program