Provider Demographics
NPI:1144488149
Name:RIPUDAMAN S BENIWAL MD INC
Entity type:Organization
Organization Name:RIPUDAMAN S BENIWAL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLEVENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-239-0515
Mailing Address - Street 1:1144 NORMAN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5925
Mailing Address - Country:US
Mailing Address - Phone:209-239-0515
Mailing Address - Fax:209-239-0504
Practice Address - Street 1:1144 NORMAN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5925
Practice Address - Country:US
Practice Address - Phone:209-239-0515
Practice Address - Fax:209-239-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA067409207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty