Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | G63152 | AR |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G63152 | CA |
N | 207YS0123X | Facial Plastic Surgeon | G63152 | CA |
NPI | 1962414011 |
---|---|
Provider Name | Judith M Blazun |
First Address | Sacramento, CA 95827-2539 |
Second Address | Sacramento, CA 95816-6004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 10/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G631520 | (05) | CA |
E89185 | (02) |