Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | C042343 | CA |
NPI | 1013012178 |
---|---|
Provider Name | Dr. Carol Joan Bennett |
First Address | Los Angeles, CA 90073-1003 |
Second Address | Los Angeles, CA 90073-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |