Healthcare Provider Details

I. General information

NPI: 1093851727
Provider Name (Legal Business Name): MARC HELMAN BLUMBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N STATE ST
HEMET CA
92543-2960
US

IV. Provider business mailing address

PO BOX 830
HEMET CA
92546-0830
US

V. Phone/Fax

Practice location:
  • Phone: 951-791-3300
  • Fax: 951-791-3333
Mailing address:
  • Phone: 951-791-3300
  • Fax: 951-791-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA33750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: