Provider Demographics
NPI:1164578811
Name:DIERAUF, BENJAMIN EDWARD (LAC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:EDWARD
Last Name:DIERAUF
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6966 SHEPHERD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1539
Mailing Address - Country:US
Mailing Address - Phone:925-297-4785
Mailing Address - Fax:925-403-1001
Practice Address - Street 1:2920 CAMINO DIABLO STE 210C
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-3958
Practice Address - Country:US
Practice Address - Phone:925-297-4785
Practice Address - Fax:925-403-1001
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC 4256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist