NPI 1093469017 · live from the CMS NPI Registry
Joshua Bennett, PA-C
Physician Assistant, Medical in San Diego, CA. National Provider Identifier 1093469017, active.
NPI record
| NPI | 1093469017 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant, Medical 363AM0700X |
| Practice location | 2450 Craven St Bldg 3300, San Diego, CA 92136 |
| Practice phone | 619-881-9202 |
| Mailing address | 2232 Nw 196th St, Edmond, OK 73012 |
| Enumerated | February 8, 2022 |
| Last updated | March 3, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant, Medical | 363AM0700X | 4748 (OK) |
| Physician Assistant | 363A00000X | 4748 (OK) |
| Physician Assistant, Medical primary | 363AM0700X | PA64095 (CA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.