Provider Demographics
NPI:1174637466
Name:HOURANI, BENJAMIN TEOFILO (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:TEOFILO
Last Name:HOURANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 MEDICAL CENTER CT
Mailing Address - Street 2:#100
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6654
Mailing Address - Country:US
Mailing Address - Phone:619-421-4000
Mailing Address - Fax:619-421-6395
Practice Address - Street 1:754 MEDICAL CENTER CT
Practice Address - Street 2:#100
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6654
Practice Address - Country:US
Practice Address - Phone:619-421-4000
Practice Address - Fax:619-421-6395
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19821207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10946OtherMEDICARE EMC
A40764Medicare UPIN
CAWG19821Medicare ID - Type Unspecified