Healthcare Provider Details

I. General information

NPI: 1265405682
Provider Name (Legal Business Name): CHARISSA LEOCADIA PACIS PE BENITO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 E SHEA BLVD STE 250
SCOTTSDALE AZ
85254-4695
US

IV. Provider business mailing address

5020 E SHEA BLVD STE 250
SCOTTSDALE AZ
85254-4695
US

V. Phone/Fax

Practice location:
  • Phone: 480-336-2229
  • Fax: 480-409-8057
Mailing address:
  • Phone: 480-336-2229
  • Fax: 480-409-8057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number40836
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: