Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | G60479 | CA |
N | 2080P0208X | Pediatric Infectious Diseases | G60479 | CA |
NPI | 1578545836 |
---|---|
Provider Name | Dr. Dean Blumberg |
First Address | Sacramento, CA 95817-2208 |
Second Address | Sacramento, CA 95817-2208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 06/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G0604790 | MEDI-CAL (01) | CA |
E71860 | (02) | CA |