Individual
JOSHUA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2450 CRAVEN ST BLDG 3300, SAN DIEGO, CA 92136-2226
(619) 881-9202
Mailing address
2232 NW 196TH ST, EDMOND, OK 73012-3636
(858) 245-0998
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
4748
OK
363AM0700X
Medical Physician Assistant
4748
OK
363AM0700X
Medical Physician Assistant
Primary
PA64095
CA
Other
Enumeration date
02/08/2022
Last updated
03/03/2025
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