Provider Demographics
NPI:1821032202
Name:BENDER, GIL (MD)
Entity Type:Individual
Prefix:DR
First Name:GIL
Middle Name:
Last Name:BENDER
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 1:3561 IRIS CIR
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-3121
Mailing Address - Country:US
Mailing Address - Phone:562-508-9667
Mailing Address - Fax:562-391-4410
Practice Address - Street 1:18344 CLARK ST
Practice Address - Street 2:SUITE 202
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3505
Practice Address - Country:US
Practice Address - Phone:818-708-8011
Practice Address - Fax:562-391-4410
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG792850174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG79285BMedicare ID - Type Unspecified
CAF89580Medicare UPIN