Provider Information for 1417716622
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
DEBRA BLALOCK
Sex: Female
NPI: 1417716622
Last Updated: 2024-03-18
Certification Date: 2024-03-05
Certification Date: 2024-03-05
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1417716622 | ||||||||
| Enumeration Date | 2024-03-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 8442 VALENCIA DR HUNTINGTON BEACH, CA 92647-6034 United States Phone: 714-343-3077 | Fax: | ||||||||
| Primary Practice Address | 550 N GOLDEN CIRCLE DR STE A SANTA ANA, CA 92705-3977 United States Phone: 714-210-9724 | Fax: | ||||||||
| Secondary Practice Address(es) | |||||||||
| Health Information Exchange |
| ||||||||
| Other Identifiers |
| ||||||||
| Taxonomy |
|