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General NPI Number Information
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NPI Number | 1548379621
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Entity Type | Individual
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Provider Name | BENEDICT JOHN MARCIANO MD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 53 ELMWOOD DR SUITE 1
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City | SAN RAMON
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State | CA
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Zip | 94583-4183
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Country | US
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Telephone | 925-487-9337
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Fax | 925-833-8556
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Provider Business Mailing Address
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Address Line | PO BOX 576649
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City | MODESTO
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State | CA
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Zip | 95357-6649
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Country | US
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Telephone | 209-573-3333
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Fax | 209-491-7184
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | A044807
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License Number State | CA
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