Healthcare Provider Details

I. General information

NPI: 1588001267
Provider Name (Legal Business Name): RICARDA BENZ MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E VALENCIA MESA DR SUITE 215
FULLERTON CA
92835-3813
US

IV. Provider business mailing address

100 E VALENCIA MESA DR SUITE 215
FULLERTON CA
92835-3813
US

V. Phone/Fax

Practice location:
  • Phone: 714-912-2211
  • Fax:
Mailing address:
  • Phone: 714-912-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG87188
License Number StateCA

VIII. Authorized Official

Name: DR. RICARDA D BENZ
Title or Position: PRESIDENT OF CORPORATION
Credential: MD
Phone: 714-912-2211