Provider Demographics
NPI:1174882807
Name:BENITES, NICHOLAS ANTHONY (PA-C)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:BENITES
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:9750 W SKYE CANYON PARK DR
Mailing Address - Street 2:STE 160 BOX 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-6627
Mailing Address - Country:US
Mailing Address - Phone:702-232-2326
Mailing Address - Fax:702-974-0440
Practice Address - Street 1:3975 S DURANGO DR STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4156
Practice Address - Country:US
Practice Address - Phone:702-628-5333
Practice Address - Fax:702-487-3599
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2024-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVPA1352363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant