Individual
BENNELLE JAMES REESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7922 PALM ST, LEMON GROVE, CA 91945-2956
(619) 464-3488
(619) 464-3416
Mailing address
3240 OLIVE ST, APT 49, LEMON GROVE, CA 91945-1768
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
10/26/2006
Last updated
07/08/2007
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