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General NPI Number Information
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NPI Number | 1245830181
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Entity Type | Individual
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Provider Name | LAUREN RAE BENNETT PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 713 N DOUGLAS ST
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City | EL SEGUNDO
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State | CA
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Zip | 90245-2830
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Country | US
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Telephone | 310-906-2788
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Fax | 310-906-2786
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Provider Business Mailing Address
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Address Line | PO BOX 48184
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City | LOS ANGELES
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State | CA
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Zip | 90048-0184
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Country | US
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Telephone | 147-865-8872
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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