NPIMap

Organization Active NPI

Port Medical Wellness, Inc.

  • Orthopaedic Surgery Physician
  • Wilmington, CA
National Provider Identifier
1104077569
Registry record updated Oct 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
PORT MEDICAL WELLNESS, INC.
Practice address
512 N Avalon Blvd
Wilmington, CA 90744-5806
Phone
(310) 816-2943
Fax
(310) 816-9393
NPI assigned
Oct 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Laurent Ruben Benhamou, D.O.NPI 1134374010
Title
Partner
Phone
(310) 522-5811

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

512 N Avalon Blvd
Wilmington, CA 90744-5806

Mailing address

PO Box 128
C/O Stella Redenski
Pacific Palisades, CA 90272-0128
Phone (310) 522-5811

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223942400000",
    "number": "1104077569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 128",
            "address_2": "C/O STELLA REDENSKI",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902720128",
            "telephone_number": "310-522-5811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907445806",
            "telephone_number": "310-816-2943",
            "fax_number": "310-816-9393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT MEDICAL WELLNESS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-03",
        "last_updated": "2008-10-14",
        "status": "A",
        "authorized_official_last_name": "BENHAMOU",
        "authorized_official_first_name": "LAURENT",
        "authorized_official_middle_name": "RUBEN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "310-522-5811",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.