Provider Demographics
NPI:1508990045
Name:RON BENBASSAT MD INC
Entity Type:Organization
Organization Name:RON BENBASSAT MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-209-1410
Mailing Address - Street 1:435 N BEDFORD DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4380
Mailing Address - Country:US
Mailing Address - Phone:310-888-2400
Mailing Address - Fax:
Practice Address - Street 1:435 N BEDFORD DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4380
Practice Address - Country:US
Practice Address - Phone:310-888-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
G76043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19374Medicare PIN