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: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8977 MIRA MESA BLVD
SAN DIEGO CA
92126-2716
US

IV. Provider business mailing address

637 3RD AVE STE E1
CHULA VISTA CA
91910-5707
US

V. Phone/Fax

Practice location:
  • Phone: 844-200-2426
  • Fax: 858-898-2880
Mailing address:
  • Phone: 844-200-2426
  • Fax: 619-356-2726

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: