Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | G53758 | CA |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | G53758 | CA |
NPI | 1043310030 |
---|---|
Provider Name | Richard I Blum |
First Address | San Diego, CA 92103-1202 |
Second Address | San Diego, CA 92103-2229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 17/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G537580 | (05) | CA |
A14092 | (02) | CA |