Provider Demographics
NPI:1457392219
Name:BENOZA, ELLA MARIE SUMARIA (MD)
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:MARIE SUMARIA
Last Name:BENOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:3031 TISCH WAY
Practice Address - Street 2:STE 400
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2541
Practice Address - Country:US
Practice Address - Phone:408-244-2100
Practice Address - Fax:408-244-6596
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65998174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A659982Medicaid
CAAY183ZMedicare PIN
CAAY183VMedicare PIN
CA00A659982Medicare PIN
CAAY183UMedicare PIN
CAH40539Medicare UPIN
CAAY183YMedicare UPIN
CAAY183XMedicare PIN
CAAY183WMedicare PIN