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General NPI Number Information
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NPI Number | 1144858077
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Entity Type | Individual
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Provider Name | OLIVIA CHARLOTTE BLACKSTONE DO
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Gender | Female
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 11209 N TATUM BLVD STE 255
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City | PHOENIX
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State | AZ
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Zip | 85028-6061
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Country | US
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Telephone | 602-494-5050
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Fax | 866-777-2248
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Provider Business Mailing Address
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Address Line | PO BOX 81064
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City | CLEVELAND
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State | OH
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Zip | 44181-0064
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Country | US
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Telephone | 602-494-5050
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Fax | 866-777-2248
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 011075
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License Number State | AZ
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