Healthcare Provider Details

I. General information

NPI: 1225368558
Provider Name (Legal Business Name): RICHARD M BENOIT MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N LARCHMONT BLVD SUITE 525
LOS ANGELES CA
90004-3025
US

IV. Provider business mailing address

321 N LARCHMONT BLVD SUITE 525
LOS ANGELES CA
90004-3025
US

V. Phone/Fax

Practice location:
  • Phone: 323-871-2214
  • Fax:
Mailing address:
  • Phone: 323-871-2214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberA63799
License Number StateCA

VIII. Authorized Official

Name: RICHARD M BENOIT
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 323-871-2214