Provider Demographics
NPI:1679749428
Name:JERRY S BENZL MD A CALIFORNIA CORPORATION
Entity Type:Organization
Organization Name:JERRY S BENZL MD A CALIFORNIA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BENZL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-348-1515
Mailing Address - Street 1:26902 OSO PKWY
Mailing Address - Street 2:180
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5815
Mailing Address - Country:US
Mailing Address - Phone:949-348-1515
Mailing Address - Fax:949-348-1512
Practice Address - Street 1:26902 OSO PKWY
Practice Address - Street 2:180
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5815
Practice Address - Country:US
Practice Address - Phone:949-348-1515
Practice Address - Fax:949-348-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34016207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27332Medicare UPIN
CAA27332Medicare Oscar/Certification