Healthcare Provider Details

I. General information

NPI: 1558499053
Provider Name (Legal Business Name): JAMES PAUL BENVENUTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E COLORADO ST
GLENDALE CA
91205-1514
US

IV. Provider business mailing address

1530 E COLORADO ST
GLENDALE CA
91205-1514
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-0222
  • Fax: 818-243-5413
Mailing address:
  • Phone: 818-244-0222
  • Fax: 818-243-5413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA22217
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberA-22217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: