Provider Demographics
NPI:1942913058
Name:AMES, BENEDETTA RAE (PA)
Entity type:Individual
Prefix:
First Name:BENEDETTA
Middle Name:RAE
Last Name:AMES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1000 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94592-1169
Mailing Address - Country:US
Mailing Address - Phone:313-870-7728
Mailing Address - Fax:
Practice Address - Street 1:3838 CALIFORNIA ST RM 715
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1509
Practice Address - Country:US
Practice Address - Phone:415-592-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAPA66665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant