Individual
CARISSA DARLENE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
11645 WILSHIRE BLVD, SUITE # 600, LOS ANGELES, CA 90025-1708
(310) 477-5558
(310) 477-7281
Mailing address
11645 WILSHIRE BLVD, SUITE # 600, LOS ANGELES, CA 90025-1708
(310) 477-5558
(310) 477-7281
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
AU759
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AUD0007590
—
CA
Enumeration date
06/14/2006
Last updated
01/28/2009
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