MEDICARE: DR. ANNA BLANKEN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY34080	CA

General Provider Information

NPI Number	:	1093422479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA BLANKEN PHD

Provider Business Mailing Address
First Line	:	4150 CLEMENT ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94121-1563
Country	:	US
Telephone Number	:	781-413-1148
Fax Number	:

Provider Business Practice Location Address
First Line	:	3962 FOREST HILL AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-2416
Country	:	US
Telephone Number	:	781-413-1148
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2022
Last Update Date	:	05/17/2024

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Directions to “ DR. ANNA BLANKEN PHD” Practice Location

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