Provider Demographics
NPI:1679771489
Name:BENALT, WENDI A (MD)
Entity type:Individual
Prefix:
First Name:WENDI
Middle Name:A
Last Name:BENALT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 BALBOA BLVD STE 199
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1515
Mailing Address - Country:US
Mailing Address - Phone:818-643-5082
Mailing Address - Fax:
Practice Address - Street 1:6345 BALBOA BLVD STE 199
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1515
Practice Address - Country:US
Practice Address - Phone:818-643-5082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442053207V00000X
PAMT190906207V00000X
CAA1239692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA213863HRUMedicare PIN