Provider Demographics
NPI:1013215540
Name:BENNETT, BESSIE
Entity Type:Individual
Prefix:
First Name:BESSIE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 FRAZEE RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4337
Mailing Address - Country:US
Mailing Address - Phone:888-748-3711
Mailing Address - Fax:888-675-7798
Practice Address - Street 1:1450 FRAZEE RD
Practice Address - Street 2:SUITE 306
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4337
Practice Address - Country:US
Practice Address - Phone:888-748-3711
Practice Address - Fax:888-675-7798
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174740164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse