Provider Demographics
NPI:1467076067
Name:BENNETT, DARLENE (CPTI)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CPTI
Other - Prefix:
Other - First Name:MOBILE
Other - Middle Name:PHLEBOTOMY
Other - Last Name:PROFESSIONALS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA/ CPTI
Mailing Address - Street 1:8450 CAROB ST
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-1221
Mailing Address - Country:US
Mailing Address - Phone:310-922-3596
Mailing Address - Fax:
Practice Address - Street 1:8450 CAROB ST
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-1221
Practice Address - Country:US
Practice Address - Phone:310-922-3596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00009782246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00009782OtherCPT1