Healthcare Provider Details

I. General information

NPI: 1740329804
Provider Name (Legal Business Name): DAVID A. BLUESTONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 WILSHIRE BLVD #215
LOS ANGELES CA
90048-5201
US

IV. Provider business mailing address

6221 WILSHIRE BLVD #215
LOS ANGELES CA
90048-5201
US

V. Phone/Fax

Practice location:
  • Phone: 323-938-7294
  • Fax: 323-954-9295
Mailing address:
  • Phone: 323-938-7294
  • Fax: 323-954-9295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG-11443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: