Provider Demographics
NPI:1932542099
Name:BENUDIZ, NATALIE RACHEL (MPAP, PA-C)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:RACHEL
Last Name:BENUDIZ
Suffix:
Gender:F
Credentials:MPAP, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11122 CASHMERE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3203
Mailing Address - Country:US
Mailing Address - Phone:310-472-5973
Mailing Address - Fax:
Practice Address - Street 1:2324 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4002
Practice Address - Country:US
Practice Address - Phone:213-383-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18482363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant