Provider Demographics
NPI:1750677167
Name:RECORD, BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:RECORD
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 1:3395 MICHELSON DR
Mailing Address - Street 2:#1224
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-4438
Mailing Address - Country:US
Mailing Address - Phone:801-674-9686
Mailing Address - Fax:
Practice Address - Street 1:3395 MICHELSON DR
Practice Address - Street 2:#1224
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-4438
Practice Address - Country:US
Practice Address - Phone:801-674-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137054207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology