Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Benjamin Portillo-Dominguez, PA-C

Individual provider Physician Assistant · NPI 1528632718

Benjamin Portillo-Dominguez, PA-C is a Physician Assistant in Reno, Nevada. Qualified in 2022, 4 years ago. Practices with Custom Physical Therapy Limited Partnership, a 81-clinician group and accepts Medicare assignment. Licensed in Nevada.

Years since qualifying
4
Licensed in
NV
In the registry since
2021
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

555 N Arlington Ave
Reno, NV 89503-4723
Phone: (775) 786-3040
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA2707 (NV)

Record details

NPI number1528632718
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMay 13, 2021
Last updated in NPPESFebruary 14, 2023
Certification dateFebruary 14, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Custom Physical Therapy Limited Partnership — 81 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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