Provider Demographics
NPI:1164438875
Name:BENNETT, ERICA CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:CHRISTINE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LA CASA VIA STE 100
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3084
Mailing Address - Country:US
Mailing Address - Phone:925-239-2900
Mailing Address - Fax:
Practice Address - Street 1:106 LA CASA VIA STE 100
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3084
Practice Address - Country:US
Practice Address - Phone:925-239-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2004-0708207Y00000X
CAA55835207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology