Individual
JOSE JR CARREON-BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
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
(714) 603-5070
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95-2633765
—
CA
Enumeration date
10/31/2023
Last updated
10/31/2023
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