Healthcare Provider Details

I. General information

NPI: 1275736621
Provider Name (Legal Business Name): MARSHALL LEWIS BLOUNT V FNP PRACTITONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2238 GEARY BLVD
SAN FRANCISCO CA
94115-3416
US

IV. Provider business mailing address

2261 VALENTANO DR
DUBLIN CA
94568-3312
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-2000
  • Fax:
Mailing address:
  • Phone: 408-230-1348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95030340
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: