Provider Demographics
NPI:1629669221
Name:PATRICK BENNET, D.O., PLLC
Entity Type:Organization
Organization Name:PATRICK BENNET, D.O., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNET
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-632-5398
Mailing Address - Street 1:732 S 6TH ST STE 200C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-6928
Mailing Address - Country:US
Mailing Address - Phone:702-586-1230
Mailing Address - Fax:
Practice Address - Street 1:1650 COMMUNITY COLLEGE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1144
Practice Address - Country:US
Practice Address - Phone:702-486-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health