Healthcare Provider Details

I. General information

NPI: 1265568364
Provider Name (Legal Business Name): CINDY BLIFELD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E OCEAN AVE STE 6
LOMPOC CA
93436-7076
US

IV. Provider business mailing address

1111 E OCEAN AVE STE 6
LOMPOC CA
93436-7076
US

V. Phone/Fax

Practice location:
  • Phone: 805-736-4970
  • Fax: 805-736-7592
Mailing address:
  • Phone: 805-736-4970
  • Fax: 805-736-7592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA43842
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberA043842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: