Healthcare Provider Details

I. General information

NPI: 1295067494
Provider Name (Legal Business Name): DAVID BENVENUTI, M.D. F.A.C.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 PLACENTIA AVE #104
NEWPORT BEACH CA
92663-3311
US

IV. Provider business mailing address

355 PLACENTIA AVE #104
NEWPORT BEACH CA
92663-3311
US

V. Phone/Fax

Practice location:
  • Phone: 949-650-2345
  • Fax: 949-650-6817
Mailing address:
  • Phone: 949-650-2345
  • Fax: 949-650-6817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberG34385
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID BENVENUTI
Title or Position: OWNER
Credential: M.D.
Phone: 949-650-2345