Healthcare Provider Details

I. General information

NPI: 1629669221
Provider Name (Legal Business Name): PATRICK BENNET, D.O., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COMMUNITY COLLEGE DR
LAS VEGAS NV
89146-1144
US

IV. Provider business mailing address

732 S 6TH ST STE 200C
LAS VEGAS NV
89101-6928
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-4400
  • Fax:
Mailing address:
  • Phone: 702-586-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK BENNET
Title or Position: OWNER
Credential: DO
Phone: 949-632-5398