Healthcare Provider Details

I. General information

NPI: 1376015578
Provider Name (Legal Business Name): STEVEN E. BLUM DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 ROSS AVE
EL CENTRO CA
92243-4306
US

IV. Provider business mailing address

PO BOX 41
MUNCIE IN
47308-0041
US

V. Phone/Fax

Practice location:
  • Phone: 760-339-7100
  • Fax:
Mailing address:
  • Phone: 765-284-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN BLUM
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 858-361-8350