Healthcare Provider Details

I. General information

NPI: 1356589634
Provider Name (Legal Business Name): CARLOS BLANCHE MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W. STEWART DRIVE SUITE 503
ORANGE CA
92868-3856
US

IV. Provider business mailing address

1310 W. STEWART DRIVE SUITE 503
ORANGE CA
92868-3856
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-2224
  • Fax: 714-997-1187
Mailing address:
  • Phone: 714-997-2224
  • Fax: 714-997-1187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CARLOS BLANCHE
Title or Position: PRESIDENT
Credential: MD
Phone: 714-296-9669