{
"Npi": {
"NPI": "1750864773",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BENITEZ",
"FirstName": "ALICIA",
"MiddleName": "E",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "12476 SW 1ST ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORAL SPRINGS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33071-8060",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-600-4113",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "68 SCHOOL RD",
"SecondLinePracticeLocationAddress": "STE 200",
"PracticeLocationAddressCityName": "FRISCO",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80443-0000",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "970-668-2510",
"PracticeLocationAddressFaxNumber": "970-668-2511",
"EnumerationDate": "09/14/2018",
"LastUpdateDate": "11/04/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA55972",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "PA.0005563",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "0010-09673",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}