Healthcare Provider Details

I. General information

NPI: 1083569743
Provider Name (Legal Business Name): BENEDICT LAGASCA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 INDUSTRIAL BLVD STE 102
WEST SACRAMENTO CA
95691-5005
US

IV. Provider business mailing address

5220 FITZWILLIAM WAY
SACRAMENTO CA
95823-4122
US

V. Phone/Fax

Practice location:
  • Phone: 916-669-9038
  • Fax: 916-529-4161
Mailing address:
  • Phone: 916-669-9038
  • Fax: 916-529-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: