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General NPI Number Information
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NPI Number | 1578647269
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Entity Type | Organization
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Legal Business Name | LUIS M BLANDO MD INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 10/25/2025
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Provider Practice Location Address
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Address Line | 222 E CLARION DR
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City | CARSON
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State | CA
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Zip | 90745-1514
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Country | US
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Telephone | 805-487-3881
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Fax | 805-487-3963
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Provider Business Mailing Address
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Address Line | 222 E CLARION DR
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City | CARSON
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State | CA
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Zip | 90745-1514
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Country | US
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Telephone | 805-487-3881
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Fax | 805-487-3963
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | GREGORIO DE GRANO
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Credential | NP
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Telephone | 818-516-8066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C41127
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License Number State | CA
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