Healthcare Provider Details

I. General information

NPI: 1174485312
Provider Name (Legal Business Name): LAUREN MARIE BENNETT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 615E
LOS ANGELES CA
90048-5910
US

IV. Provider business mailing address

3137 HOOP PINE PL
SIMI VALLEY CA
93065-7235
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-8132
  • Fax:
Mailing address:
  • Phone: 805-416-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: