Doctor Name: | DR. DONALD RICHMOND BENNETT |
NPI Number: | 1558569533 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | A 104991 |
Business Practice Address: | 310 S Twin Oaks Valley Rd #107-214 San Marcos, CA - 920784303 |
Business Phone Number: | 7607057705 |
Business Fax Number: | |
Mailing Address: | 310 S Twin Oaks Valley Rd, #107-214 SAN MARCOS |
State: | CA |
Postal Code: | 920784303 |
Phone Number: | 7607057705 |
Fax Number: | |
NPI Enumeration Date: | 07/11/2007 |
NPI Last Update Date: | 07/17/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A 104991 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |