Individual
BERNARD LEROY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
661 W 1ST ST STE G, TUSTIN, CA 92780-2939
(714) 665-9890
(714) 665-9891
Mailing address
661 W 1ST ST STE G, TUSTIN, CA 92780-2939
(714) 665-9890
(714) 665-9891
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
C42114
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1028P
BLUE CROSS
NC
05
—
891028P
—
NC
01
—
DA5493
MEDICARE RAILROAD
NC
01
—
DO0034
MEDICARE RAILROAD
NC
01
—
P00062870
MEDICARE RAILROAD
NC
01
—
P00651283
MEDICARE RAILROAD
NC
Enumeration date
02/22/2006
Last updated
08/08/2024
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