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General NPI Number Information
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NPI Number | 1528039799
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Entity Type | Individual
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Provider Name | RIPUDAMAN S BENIWAL MD
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Gender | Male
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 1144 NORMAN DR STE 101 1530 N BESSIE AVE, STE104, TRACY CA 95376 ( 2ND OFFICE)
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City | MANTECA
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State | CA
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Zip | 95336-5959
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Country | US
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Telephone | 209-239-0515
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Fax | 209-239-0504
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Provider Business Mailing Address
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Address Line | 1144 NORMAN DR STE 101
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City | MANTECA
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State | CA
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Zip | 95336-5959
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Country | US
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Telephone | 209-835-2992
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Fax | 209-835-3296
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A67409
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License Number State | CA
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