Healthcare Provider Details

I. General information

NPI: 1669453254
Provider Name (Legal Business Name): RICARDA D BENZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 714-912-2211
  • Fax: 714-213-8750
Mailing address:
  • Phone: 714-912-2211
  • Fax: 714-213-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: