MEDICARE: MELETTE LE BLANC-CABOT

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	363A00000X	Physician Assistant	13691	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	XEHJ01812243	OTHER		BLUE SHIELD

General Provider Information

NPI Number	:	1942638630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELETTE LE BLANC-CABOT

Provider Business Mailing Address
First Line	:	1241 E DYER RD
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5611
Country	:	US
Telephone Number	:	888-306-0615
Fax Number	:

Provider Business Practice Location Address
First Line	:	1241 E DYER RD
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5611
Country	:	US
Telephone Number	:	888-306-0615
Fax Number	:

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

Provider Enumeration Date	:	10/16/2013
Last Update Date	:	11/26/2014

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