=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265405682
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARISSA LEOCADIA PACIS PE BENITO M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2006
-----------------------------------------------------
Last Update Date | 11/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5020 E SHEA BLVD STE 250
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254-4695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-336-2229
-----------------------------------------------------
Fax | 480-409-8057
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5020 E SHEA BLVD STE 250
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254-4695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-336-2229
-----------------------------------------------------
Fax | 480-409-8057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0006X
-----------------------------------------------------
Taxonomy Name | Developmental - Behavioral Pediatrics Physician
-----------------------------------------------------
License Number | 40836
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------