Healthcare Provider Details

I. General information

NPI: 1013749837
Provider Name (Legal Business Name): GARY ELDON BLUNT RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 KLUMP AVE APT 214
NORTH HOLLYWOOD CA
91601-4904
US

IV. Provider business mailing address

5315 TORRANCE BLVD STE B1
TORRANCE CA
90503-4011
US

V. Phone/Fax

Practice location:
  • Phone: 424-731-2249
  • Fax: 562-402-3336
Mailing address:
  • Phone: 800-829-8660
  • Fax: 562-402-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number818001
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number818001
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number818001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: