Healthcare Provider Details

I. General information

NPI: 1790031227
Provider Name (Legal Business Name): OSCAR BLANCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 BRUNSWICK ST
SAN FRANCISCO CA
94112-4202
US

IV. Provider business mailing address

1001 SNEATH LN STE 307
SAN BRUNO CA
94066-2349
US

V. Phone/Fax

Practice location:
  • Phone: 650-244-1444
  • Fax: 650-244-1447
Mailing address:
  • Phone: 650-244-1444
  • Fax: 650-244-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: