MEDICARE: NICHOLAS ANTHONY BENITES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA1352	NV

General Provider Information

NPI Number	:	1174882807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS ANTHONY BENITES PA-C

Provider Business Mailing Address
First Line	:	9750 W SKYE CANYON PARK DR
Second Line	:	STE 160 BOX 103
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-6627
Country	:	US
Telephone Number	:	702-232-2326
Fax Number	:	702-974-0440

Provider Business Practice Location Address
First Line	:	3975 S DURANGO DR STE 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-4156
Country	:	US
Telephone Number	:	702-628-5333
Fax Number	:	702-487-3599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2012
Last Update Date	:	10/14/2024

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Directions to “ NICHOLAS ANTHONY BENITES PA-C” Practice Location

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