Provider Demographics
NPI:1528039799
Name:BENIWAL, RIPUDAMAN S (MD)
Entity Type:Individual
Prefix:MR
First Name:RIPUDAMAN
Middle Name:S
Last Name:BENIWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1144 NORMAN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5959
Mailing Address - Country:US
Mailing Address - Phone:209-835-2992
Mailing Address - Fax:209-835-3296
Practice Address - Street 1:1144 NORMAN DR STE 101
Practice Address - Street 2:1530 N BESSIE AVE, STE104, TRACY CA 95376 ( 2ND OFFICE)
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5959
Practice Address - Country:US
Practice Address - Phone:209-239-0515
Practice Address - Fax:209-239-0504
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA67409207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A674090Medicaid
H70534Medicare UPIN
CA00A674090Medicare ID - Type Unspecified