Provider Demographics
NPI:1689180341
Name:BENJAMIN, LINDA (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
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 1:1949 W RAY RD STE 23
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4008
Mailing Address - Country:US
Mailing Address - Phone:480-917-1720
Mailing Address - Fax:480-917-6934
Practice Address - Street 1:1949 W RAY RD STE 23
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4008
Practice Address - Country:US
Practice Address - Phone:480-917-1720
Practice Address - Fax:480-917-6934
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6999208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation