Provider Demographics
NPI:1730214602
Name:PJ BENIPAL MD INC
Entity type:Organization
Organization Name:PJ BENIPAL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-347-2722
Mailing Address - Street 1:116 S PALISADE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8906
Mailing Address - Country:US
Mailing Address - Phone:805-347-7355
Mailing Address - Fax:805-347-7354
Practice Address - Street 1:116 S PALISADE DR STE 210
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8906
Practice Address - Country:US
Practice Address - Phone:805-347-7355
Practice Address - Fax:805-347-7354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64620207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A646200Medicaid
CAA64620OtherLICENSE NUMBER
CAW18134Medicare PIN
CA00A646200Medicaid
CAH66033Medicare UPIN