Healthcare Provider Details

I. General information

NPI: 1548379621
Provider Name (Legal Business Name): BENEDICT JOHN MARCIANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 ELMWOOD DR SUITE 1
SAN RAMON CA
94583-4183
US

IV. Provider business mailing address

PO BOX 576649
MODESTO CA
95357-6649
US

V. Phone/Fax

Practice location:
  • Phone: 925-487-9337
  • Fax: 925-833-8556
Mailing address:
  • Phone: 209-573-3333
  • Fax: 209-491-7184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA044807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: