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General NPI Number Information
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NPI Number | 1265616015
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Entity Type | Individual
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Provider Name | BARBARA JILL BENNETT C.P.N.P.
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Gender | Female
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 10861 CHERRY ST STE 305
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-5403
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Country | US
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Telephone | 562-598-4848
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Fax | 562-598-5949
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Provider Business Mailing Address
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Address Line | 10861 CHERRY ST STE 305
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-5403
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Country | US
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Telephone | 562-598-4848
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Fax | 562-598-5949
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 192900
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License Number State | CA
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