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General NPI Number Information
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NPI Number | 1598423865
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Entity Type | Individual
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Provider Name | SEAN KELLER BLUM RN
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Gender | Male
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Dates
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Enumeration Date | 12/03/2021
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 333 SKYWAY DR
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City | CAMARILLO
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State | CA
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Zip | 93010-8552
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Country | US
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Telephone | 805-383-1155
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Fax | 805-383-1134
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Provider Business Mailing Address
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Address Line | 333 SKYWAY DR
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City | CAMARILLO
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State | CA
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Zip | 93010-8552
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Country | US
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Telephone | 805-702-5210
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Fax | 805-383-1134
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95214717
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License Number State | CA
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