Healthcare Provider Details

I. General information

NPI: 1619014404
Provider Name (Legal Business Name): MARY C. BLINDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W METROPOLITAN DR STE 405
ORANGE CA
92868-3504
US

IV. Provider business mailing address

4000 W METROPOLITAN DR STE 405
ORANGE CA
92868-3504
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-4669
  • Fax:
Mailing address:
  • Phone: 714-480-4669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number216753
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG75085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: