Provider Demographics
NPI:1265405682
Name:PE BENITO, CHARISSA LEOCADIA PACIS (MD)
Entity type:Individual
Prefix:
First Name:CHARISSA LEOCADIA
Middle Name:PACIS
Last Name:PE BENITO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5020 E SHEA BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4695
Mailing Address - Country:US
Mailing Address - Phone:480-336-2229
Mailing Address - Fax:480-409-8057
Practice Address - Street 1:5020 E SHEA BLVD STE 250
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4695
Practice Address - Country:US
Practice Address - Phone:480-336-2229
Practice Address - Fax:480-409-8057
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ408362080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKI21262Medicare UPIN
OK200038740AMedicaid