Healthcare Provider Details

I. General information

NPI: 1720174410
Provider Name (Legal Business Name): BLESILDA MARIO-SINGH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 EAST VALLEY PARKWAY
ESCONDIDO CA
92025
US

IV. Provider business mailing address

PO BOX 744127
DALLAS TX
75374-4127
US

V. Phone/Fax

Practice location:
  • Phone: 760-739-3030
  • Fax: 760-739-2604
Mailing address:
  • Phone: 760-739-3039
  • Fax: 972-498-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberA35606
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA35606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: