Healthcare Provider Details

I. General information

NPI: 1063506806
Provider Name (Legal Business Name): DUMONT GARY BLANKENSHIP PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 VISTA WAY 205
OCEANSIDE CA
92056-3619
US

IV. Provider business mailing address

3210 GARRISON ST
SAN DIEGO CA
92106-2110
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-1480
  • Fax: 760-435-9472
Mailing address:
  • Phone: 619-224-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY8627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: