# PORT MEDICAL WELLNESS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104077569
- **Authorized official:** DR. LAURENT RUBEN BENHAMOU D.O. (PARTNER)
- **Authorized official phone:** (310) 522-5811

## Contact information

- **Practice address:** 512 N AVALON BLVD, WILMINGTON, CA 90744-5806
- **Practice address phone:** (310) 816-2943
- **Practice address fax:** (310) 816-9393
- **Mailing address:** PO BOX 128, C/O STELLA REDENSKI, PACIFIC PALISADES, CA 90272-0128
- **Mailing address phone:** (310) 522-5811

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 171100000X | Acupuncturist | — | NULL | — |
| 171100000X | Acupuncturist | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |

## Other

- **Enumeration date:** 10/03/2008
- **Last updated:** 10/14/2008