Individual
RICHARD GARY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1301 20TH ST, SUITE 570, SANTA MONICA, CA 90404-2050
(310) 315-0171
(310) 828-6647
Mailing address
1301 20TH ST, SUITE 570, SANTA MONICA, CA 90404-2050
(310) 315-0171
(310) 828-6647
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G50297
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G502970
MEDICAL PPIN #
CA
Enumeration date
07/10/2006
Last updated
07/08/2007
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