Healthcare Provider Details

I. General information

NPI: 1932542099
Provider Name (Legal Business Name): NATALIE RACHEL BENUDIZ MPAP, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 W PICO BLVD
LOS ANGELES CA
90006-4002
US

IV. Provider business mailing address

11122 CASHMERE ST
LOS ANGELES CA
90049-3203
US

V. Phone/Fax

Practice location:
  • Phone: 213-383-3600
  • Fax:
Mailing address:
  • Phone: 310-472-5973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: