Provider Demographics
NPI:1659489425
Name:CONTRERAS, BENITO RUBEN (PA-C)
Entity Type:Individual
Prefix:
First Name:BENITO
Middle Name:RUBEN
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16600 ORANGE AVE
Mailing Address - Street 2:#104
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5353
Mailing Address - Country:US
Mailing Address - Phone:562-790-2428
Mailing Address - Fax:562-790-2428
Practice Address - Street 1:8556 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-4015
Practice Address - Country:US
Practice Address - Phone:562-861-0101
Practice Address - Fax:562-861-9898
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18278363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant