Healthcare Provider Details

I. General information

NPI: 1508304684
Provider Name (Legal Business Name): BENJAMIN CONTESSA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 UNSER BLVD NW STE 500
ALBUQUERQUE NM
87120-3936
US

IV. Provider business mailing address

2001 GOLD AVE SE UNIT B
ALBUQUERQUE NM
87106-4199
US

V. Phone/Fax

Practice location:
  • Phone: 505-205-1271
  • Fax:
Mailing address:
  • Phone: 865-978-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3220
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2021-0043
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-847
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2021-0043
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: