Provider Demographics
NPI:1134297641
Name:BENCK, MARILYN OLUFS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:OLUFS
Last Name:BENCK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:236 MAJORS ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2510
Mailing Address - Country:US
Mailing Address - Phone:559-824-3458
Mailing Address - Fax:559-433-1843
Practice Address - Street 1:23638 SKY HARBOUR ROAD
Practice Address - Street 2:
Practice Address - City:FRIANT
Practice Address - State:CA
Practice Address - Zip Code:93626
Practice Address - Country:US
Practice Address - Phone:559-822-3785
Practice Address - Fax:559-822-2928
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG42148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48837Medicare UPIN