=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659682094
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANELLE ANNE BENNETT M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2010
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2557 MOWRY AVE STE 34
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-1614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-794-5320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7999 GATEWAY BLVD STE 200
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94560-1197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-974-8274
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | A150967
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------