Provider Demographics
NPI:1174302251
Name:BENJAMIN, DIAMOND MALIKA (INDEPENDENT PROVIDER)
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:MALIKA
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 LOOP DR APT 236
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1155
Mailing Address - Country:US
Mailing Address - Phone:216-386-3049
Mailing Address - Fax:
Practice Address - Street 1:2540 LOOP DR APT 236
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-1155
Practice Address - Country:US
Practice Address - Phone:216-386-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child