Healthcare Provider Details

I. General information

NPI: 1699882423
Provider Name (Legal Business Name): MARSHAL ALAN BLATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23625 HOLMAN HWY
MONTEREY CA
93940-5902
US

IV. Provider business mailing address

P O BOX HH BUSINESS DEVELOPMENT & CONTRACTING
MONTEREY CA
93942
US

V. Phone/Fax

Practice location:
  • Phone: 831-624-5311
  • Fax: 831-625-4948
Mailing address:
  • Phone: 831-622-2716
  • Fax: 831-625-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG69127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: