Provider Demographics
NPI:1538269097
Name:BENBASSAT, RON (MD)
Entity type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:BENBASSAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 N BEDFORD DR
Mailing Address - Street 2:SUITE #300
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-888-2400
Mailing Address - Fax:310-888-2401
Practice Address - Street 1:435 N BEDFORD DR
Practice Address - Street 2:SUITE #300
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-888-2400
Practice Address - Fax:310-888-2401
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG076043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G760430Medicaid
F86538Medicare UPIN
CA00G760430Medicaid