Provider Demographics
NPI:1487734182
Name:OREJUDOS, BENJAMIN CORPUZ (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CORPUZ
Last Name:OREJUDOS
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93062-0190
Mailing Address - Country:US
Mailing Address - Phone:805-522-5940
Mailing Address - Fax:805-522-6401
Practice Address - Street 1:2400 E 4TH ST
Practice Address - Street 2:PARADISE VALLEY HOSPITAL
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2026
Practice Address - Country:US
Practice Address - Phone:619-470-4190
Practice Address - Fax:619-470-4197
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA318142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A318140Medicaid
WA31814CMedicare ID - Type Unspecified
CA00A318140Medicaid