Healthcare Provider Details

I. General information

NPI: 1437496478
Provider Name (Legal Business Name): CHRISTOPHER ALAN BLUBAUGH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY
BERKELEY CA
94720-4301
US

IV. Provider business mailing address

2492 BERKSHIRE LN
BRENTWOOD CA
94513-5023
US

V. Phone/Fax

Practice location:
  • Phone: 510-643-5808
  • Fax:
Mailing address:
  • Phone: 925-240-0636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number712422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: