Provider Demographics
NPI:1639173289
Name:BENZIAN, LURLEEN M (MD)
Entity Type:Individual
Prefix:MRS
First Name:LURLEEN
Middle Name:M
Last Name:BENZIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LURLEEN
Other - Middle Name:R
Other - Last Name:MADUCDOC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:334 S PATTERSON AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2475
Mailing Address - Country:US
Mailing Address - Phone:805-964-1514
Mailing Address - Fax:
Practice Address - Street 1:334 S PATTERSON AVE
Practice Address - Street 2:STE 105
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2475
Practice Address - Country:US
Practice Address - Phone:805-964-1514
Practice Address - Fax:805-964-0861
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82200207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F37049Medicare ID - Type Unspecified