Provider Demographics
NPI:1881797140
Name:LADDARAN, BENITO P (MD)
Entity type:Individual
Prefix:DR
First Name:BENITO
Middle Name:P
Last Name:LADDARAN
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 1:2105 BEVERLY BLVD
Mailing Address - Street 2:STE 117
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:213-413-8742
Mailing Address - Fax:213-413-6482
Practice Address - Street 1:2105 BEVERLY BLVD
Practice Address - Street 2:STE 117
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-413-8742
Practice Address - Fax:213-413-6482
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3659102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84897OtherUPIN
CAGR0064390OtherMEDICAL
CAA84897OtherUPIN