Provider Demographics
NPI:1285415141
Name:BENITEZ, MARA YMER (NP)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:YMER
Last Name:BENITEZ
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 1:1020 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6725
Mailing Address - Country:US
Mailing Address - Phone:209-261-6946
Mailing Address - Fax:
Practice Address - Street 1:3349 G ST STE F
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0978
Practice Address - Country:US
Practice Address - Phone:209-261-6946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF09230489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily