Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | A74117 | CA |
NPI | 1013953520 |
---|---|
Provider Name | Dr. Andrew M. Blecher |
First Address | Van Nuys, CA 91405-3796 |
Second Address | Van Nuys, CA 91405-3796 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 10/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H90066 | (02) | CA |