Provider Demographics
NPI:1124045935
Name:BENDEREV, THEODORE VAL (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:VAL
Last Name:BENDEREV
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28432 VIA MAMBRINO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3346
Mailing Address - Country:US
Mailing Address - Phone:949-584-7505
Mailing Address - Fax:
Practice Address - Street 1:26800 CROWN VALLEY PKWY STE 475
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8027
Practice Address - Country:US
Practice Address - Phone:888-827-3286
Practice Address - Fax:949-364-2829
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43662208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA 89787Medicare UPIN
CAWG43662CMedicare ID - Type Unspecified