Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003047911 |
---|---|
Provider Name | Dr. Bennett Annan |
First Address | Simi Valley, CA 93065-1553 |
Second Address | Simi Valley, CA 93065-1553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2009 |
Last Update Date | 10/09/2018 |