Provider Demographics
NPI:1134385164
Name:PENA BENITEZ, FRIDA RINETH (MD)
Entity type:Individual
Prefix:
First Name:FRIDA
Middle Name:RINETH
Last Name:PENA BENITEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FRIDA
Other - Middle Name:RINETH
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:301 S 320TH ST
Mailing Address - Street 2:FEDERAL WAY MEDICAL CENTER
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5200
Mailing Address - Country:US
Mailing Address - Phone:253-874-7088
Mailing Address - Fax:
Practice Address - Street 1:10510 GRAVELLY LAKE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-5036
Practice Address - Country:US
Practice Address - Phone:253-589-7030
Practice Address - Fax:253-589-7033
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABC60249837207Q00000X
WAMD60242838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine