Provider Demographics
NPI:1922055086
Name:BENBASSAT, MAXIM N (MD)
Entity Type:Individual
Prefix:
First Name:MAXIM
Middle Name:N
Last Name:BENBASSAT
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:PO BOX 5486
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5486
Mailing Address - Country:US
Mailing Address - Phone:818-550-0900
Mailing Address - Fax:818-550-0900
Practice Address - Street 1:323 S HELIOTROPE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2914
Practice Address - Country:US
Practice Address - Phone:626-825-1455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67933207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A679330OtherBLUE SHIELD
CA00A679330Medicaid
CAWA67933AMedicare ID - Type Unspecified
CAP00048338OtherRAILROAD MEDICARE
H86500Medicare UPIN
CA00A679330328OtherCALOPTIMA