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General NPI Number Information
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NPI Number | 1750864773
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Entity Type | Individual
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Provider Name | ALICIA E BENITEZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 68 SCHOOL RD STE 200
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City | FRISCO
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State | CO
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Zip | 80443-0000
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Country | US
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Telephone | 970-668-2510
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Fax | 970-668-2511
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Provider Business Mailing Address
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Address Line | 12476 SW 1ST ST
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-8060
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Country | US
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Telephone | 954-600-4113
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA55972
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA.0005563
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-09673
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License Number State | NC
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