Individual
LARA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2601 E ROOSEVELT ST, PHOENIX, AZ 85008-4973
(623) 344-6700
Mailing address
2929 E THOMAS RD, PHOENIX, AZ 85016-8034
(602) 470-5043
(602) 470-5064
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
6229
AZ
Other
Enumeration date
10/15/2015
Last updated
10/15/2015
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