=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235763996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VASECTOMY INSTITUTE OF CALIFORNIA A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2020
-----------------------------------------------------
Last Update Date | 04/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26800 CROWN VALLEY PKWY STE 475
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-8027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-584-7505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28432 VIA MAMBRINO
-----------------------------------------------------
City | SAN JUAN CAPISTRANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92675-3346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-584-7505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. THEODORE BENDEREV
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 949-584-7505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------