Individual
BENNIE LISSETTE CARLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
43520 DIVISION ST, LANCASTER, CA 93535-4089
(661) 266-4783
(661) 266-1210
Mailing address
43520 DIVISION ST, LANCASTER, CA 93535-4089
(661) 266-4783
(661) 266-1210
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2633765
—
CA
Enumeration date
09/24/2025
Last updated
09/24/2025
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