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General NPI Number Information
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NPI Number | 1265875819
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Entity Type | Individual
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Provider Name | DEBRA EILEEN BENNETT NP
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Gender | Female
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Dates
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Enumeration Date | 04/14/2013
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Last Update Date | 04/14/2013
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Provider Practice Location Address
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Address Line | 9850 GENESEE AVE SUITE 570
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City | LA JOLLA
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State | CA
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Zip | 92037-1224
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Country | US
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Telephone | 858-200-3007
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Fax |
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Provider Business Mailing Address
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Address Line | 3554 BACONTREE PL
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City | SAN DIEGO
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State | CA
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Zip | 92111-4728
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Country | US
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Telephone | 619-540-0283
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 22962
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License Number State | CA
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