Active NPI
Debra Eileen Bennett, NP
- Nurse Practitioner
- La Jolla, CA
National Provider Identifier
1265875819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 22962
- Practice address
- 9850 Genesee Ave
Suite 570
La Jolla, CA 92037-1224 - Phone
- (858) 200-3007
- NPI assigned
- Apr 14, 2013
- Last updated
- Apr 14, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 22962 | CA | Primary |
Addresses
Primary practice location
9850 Genesee Ave
Suite 570
La Jolla, CA 92037-1224
Mailing address
3554 Bacontree PL
San Diego, CA 92111-4728
Phone (619) 540-0283
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22962 | CA | MD | Neonatal/Pediatric Registered Respiratory Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365897600000",
"number": "1265875819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3554 BACONTREE PL",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921114728",
"telephone_number": "619-540-0283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9850 GENESEE AVE",
"address_2": "SUITE 570",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920371224",
"telephone_number": "858-200-3007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "DEBRA",
"middle_name": "EILEEN",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-04-14",
"last_updated": "2013-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "22962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Jolla, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.