Provider Demographics
NPI:1285752832
Name:BENDANA, RAUL JAUQUIN (MD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:JAUQUIN
Last Name:BENDANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 AND A HALF WEST PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015
Mailing Address - Country:US
Mailing Address - Phone:213-487-0615
Mailing Address - Fax:213-381-2251
Practice Address - Street 1:1619 AND A HALF WEST PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015
Practice Address - Country:US
Practice Address - Phone:213-487-0615
Practice Address - Fax:213-381-2251
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA040680208800000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208800000XAllopathic & Osteopathic PhysiciansUrology
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A406800Medicaid
CAA85486Medicare UPIN
CA00A406800Medicaid