Provider Demographics
NPI:1801289939
Name:ARDA, CARMENCITA BENITO (NP)
Entity type:Individual
Prefix:
First Name:CARMENCITA
Middle Name:BENITO
Last Name:ARDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 N PERRIS BLVD
Mailing Address - Street 2:SUITE G1
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-4726
Mailing Address - Country:US
Mailing Address - Phone:951-956-2400
Mailing Address - Fax:951-956-2345
Practice Address - Street 1:1675 N PERRIS BLVD
Practice Address - Street 2:SUITE G1
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-4726
Practice Address - Country:US
Practice Address - Phone:951-956-2400
Practice Address - Fax:951-956-2345
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95001873363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01492737 - DU4034OtherRAILROAD MEDICARE
CAEFF: 5/8/2015Medicaid
CAP01492737 - DU4034OtherRAILROAD MEDICARE