Provider Demographics
NPI:1063512317
Name:BENZWI, BARBARA JILL (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JILL
Last Name:BENZWI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2322
Mailing Address - Country:US
Mailing Address - Phone:510-535-4000
Mailing Address - Fax:510-535-4128
Practice Address - Street 1:3451 E 12TH STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601
Practice Address - Country:US
Practice Address - Phone:510-535-3319
Practice Address - Fax:510-535-4187
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55-1975OtherFQHC MEDICARE PART A
CAZZZ79046ZOtherMEDICARE PART B PROVIDER NUMBER
CAZZZ29799ZOtherMEDICARE PART B PROVIDER NUMBER
CAFHC71021FMedicaid
CAHAP71021FOtherFPACT
CAFHC71021FMedicaid