Healthcare Provider Details

I. General information

NPI: 1750674685
Provider Name (Legal Business Name): CARLA BLIEDEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6744 BALBOA BLVD
LAKE BALBOA CA
91406-5532
US

IV. Provider business mailing address

6744 BALBOA BLVD
LAKE BALBOA CA
91406-5532
US

V. Phone/Fax

Practice location:
  • Phone: 818-854-1347
  • Fax: 818-787-7256
Mailing address:
  • Phone: 818-854-1347
  • Fax: 818-787-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: