MEDICARE: MARTA BLESA MD A PROFESSIONAL CORPORATION

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	208D00000X	General Practice Physician	A31530	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972819977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTA BLESA MD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	5821 TEMPLE CITY BLVD
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2113
Country	:	US
Telephone Number	:	626-287-8261
Fax Number	:	626-287-1473

Provider Business Practice Location Address
First Line	:	5821 TEMPLE CITY BLVD
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2113
Country	:	US
Telephone Number	:	626-287-8261
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TINA RAMIREZ
Credential	:
Telephone Number	:	626-287-8261

Provider Enumeration Date	:	08/27/2010
Last Update Date	:	01/03/2012

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