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NPI Code Detail

MEDICARE: SUZANNE CAMP BENTLEY NP

MEDICARE: SUZANNE CAMP BENTLEY NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerNP8411CA

General Provider Information

NPI Number : 1083648844
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUZANNE CAMP BENTLEY NP
Provider Business Mailing Address
First Line : 823 GATEWAY CENTER WAY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-4541
Country : US
Telephone Number : 619-515-2323
Fax Number : 619-906-4564
Provider Business Practice Location Address
First Line : 5454 EL CAJON BLVD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92115-3621
Country : US
Telephone Number : 619-515-2400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 03/17/2018

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