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General NPI Number Information
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NPI Number | 1598774259
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Entity Type | Individual
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Provider Name | CARL I BLAU M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5400 BALBOA BLVD STE #228
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City | ENCINO
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State | CA
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Zip | 91316-1502
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Country | US
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Telephone | 818-886-6848
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Fax | 818-886-0352
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Provider Business Mailing Address
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Address Line | PO BOX 260710
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City | ENCINO
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State | CA
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Zip | 91426-0710
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Country | US
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Telephone | 818-886-6848
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Fax | 818-886-0352
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | A23803
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License Number State | CA
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