Provider Demographics
NPI:1245830181
Name:BENNETT, LAUREN RAE (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:RAE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48184
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-0184
Mailing Address - Country:US
Mailing Address - Phone:147-865-8872
Mailing Address - Fax:
Practice Address - Street 1:3661 TORRANCE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4898
Practice Address - Country:US
Practice Address - Phone:310-370-5670
Practice Address - Fax:310-601-5056
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant