Tracy Travina Bennett, RN
Individual provider Active NPI Administrator Registered Nurse · Alta Loma, CA
NPI 1285243444 · NPPES record last updated Jul 23, 2020
Key facts
- NPI
- 1285243444
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Administrator Registered Nurse 163WA2000X
- License
- 511336 (CA)
- Practice address
- 10762 Wilson Ave
Alta Loma, CA 91737-2436 - Phone
- (909) 322-2081
- NPI assigned
- Jul 23, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 511336 | CA | MD | Administrator Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Administrator Registered Nurse | 163WA2000X | 511336 | CA | Yes |
Addresses
Primary practice location
10762 Wilson Ave
Alta Loma, CA 91737-2436
Mailing address
140 Harvard Ave Unit 1736
Claremont, CA 91711-7180
Phone (909) 322-2081
Other providers in Alta Loma, CA
- Apsis Medical Billing Services
- Karen Marie Asbra
- Julie Barthelemy
- Jordan Bartolome
- John Michael Beemer
- William A Bescoby
- Aimee Blair
- Kimberly Bolduc I
- Brittany Boone
- Cynthia Briscoe
All providers in Alta Loma, CA · Administrator Registered Nurse in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.