Provider Demographics
NPI:1184055295
Name:MORET, BENJAMIN (FNP-C)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:MORET
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 Y ST STE 3740
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-7463
Mailing Address - Fax:916-734-6493
Practice Address - Street 1:3301 C ST STE 1500
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3371
Practice Address - Country:US
Practice Address - Phone:916-734-7463
Practice Address - Fax:915-734-6493
Is Sole Proprietor?:No
Enumeration Date:2013-11-29
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000025363L00000X
CA9500025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner