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General NPI Number Information
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NPI Number | 1013215540
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Entity Type | Individual
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Provider Name | BESSIE BENNETT
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Gender | Female
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Dates
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Enumeration Date | 03/08/2011
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 1450 FRAZEE RD SUITE 306
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City | SAN DIEGO
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State | CA
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Zip | 92108-4337
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Country | US
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Telephone | 888-748-3711
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Fax | 888-675-7798
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Provider Business Mailing Address
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Address Line | 1450 FRAZEE RD SUITE 306
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City | SAN DIEGO
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State | CA
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Zip | 92108-4337
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Country | US
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Telephone | 888-748-3711
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Fax | 888-675-7798
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 174740
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License Number State | CA
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