Healthcare Provider Details

I. General information

NPI: 1770446361
Provider Name (Legal Business Name): CLAIRE ROUSH BENNETT ADMIN SERVICES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 CAPE HORN AVE
JULIAN CA
92036
US

IV. Provider business mailing address

363 REFLECTIONS AVE
PONTE VEDRA FL
32081-1186
US

V. Phone/Fax

Practice location:
  • Phone: 619-832-1220
  • Fax:
Mailing address:
  • Phone: 619-832-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number220285982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: