Provider Demographics
NPI:1992993604
Name:BENEDICTO, ERICA (PA-C)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BENEDICTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S COLORADO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-2700
Mailing Address - Country:US
Mailing Address - Phone:512-376-9690
Mailing Address - Fax:512-398-3755
Practice Address - Street 1:300 S COLORADO ST
Practice Address - Street 2:SUITE A
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-2700
Practice Address - Country:US
Practice Address - Phone:512-376-9690
Practice Address - Fax:512-398-3755
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant