Healthcare Provider Details

I. General information

NPI: 1396711644
Provider Name (Legal Business Name): ELLEN AMBAS BLANDO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 MAIN ST
RAMONA CA
92065-2125
US

IV. Provider business mailing address

PO BOX 28199
SAN DIEGO CA
92198-0199
US

V. Phone/Fax

Practice location:
  • Phone: 760-789-5160
  • Fax:
Mailing address:
  • Phone: 858-613-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA65631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: