Individual
TRACY TRAVINA BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
10762 WILSON AVE, ALTA LOMA, CA 91737-2436
(909) 322-2081
Mailing address
140 HARVARD AVE UNIT 1736, CLAREMONT, CA 91711-7180
(909) 322-2081
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
511336
CA
Other
Enumeration date
07/23/2020
Last updated
07/23/2020
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