Provider Demographics
NPI:1699708966
Name:BENVENUTI, THOMAS G (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:BENVENUTI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:520 SUPERIOR AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3637
Mailing Address - Country:US
Mailing Address - Phone:949-478-7373
Mailing Address - Fax:949-650-2898
Practice Address - Street 1:520 SUPERIOR AVENUE
Practice Address - Street 2:SUITE 330
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-478-7373
Practice Address - Fax:949-650-2898
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2012-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG52876207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG52876OtherSTATE LICENSE
CAG52876OtherSTATE LICENSE