Provider Demographics
NPI:1942214770
Name:BENITEZ, SARA G (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:G
Last Name:BENITEZ
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 1:6108 W MERCER WAY
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4849
Mailing Address - Country:US
Mailing Address - Phone:206-250-5806
Mailing Address - Fax:
Practice Address - Street 1:4800 SAND POINT WAY NE MS M1-3
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-2640
Practice Address - Fax:206-987-2720
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004883363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8441925Medicaid
MT4307256Medicaid
MT4307256Medicaid
WA8441925Medicaid