Individual
JASON BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8070 W RUSSELL RD, 1092, LAS VEGAS, NV 89113-1549
(410) 205-5292
Mailing address
8070 W RUSSELL RD, 1092, LAS VEGAS, NV 89113-1549
(410) 205-5292
Taxonomy
Speciality
Code
Description
License number
State
283X00000X
Rehabilitation Hospital
Primary
11-0109
NV
Other
Enumeration date
11/28/2016
Last updated
11/28/2016
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