Provider Demographics
NPI:1912915364
Name:BENVENUTI, DAREL J (MD)
Entity Type:Individual
Prefix:
First Name:DAREL
Middle Name:J
Last Name:BENVENUTI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:520 SUPERIOR AVENUE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3637
Mailing Address - Country:US
Mailing Address - Phone:949-478-7373
Mailing Address - Fax:949-650-2898
Practice Address - Street 1:355 PLACENTIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3311
Practice Address - Country:US
Practice Address - Phone:949-650-4322
Practice Address - Fax:949-650-2898
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG39572207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A47858Medicare UPIN