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General NPI Number Information
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NPI Number | 1790954600
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Entity Type | Individual
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Provider Name | BAMBI L. BLITZ MASTERS DEGREE
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Gender | Female
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 09/10/2009
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Provider Practice Location Address
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Address Line | 527 CROCKER ST
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City | LOS ANGELES
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State | CA
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Zip | 90013-2116
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Country | US
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Telephone | 213-488-9559
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Fax | 213-683-0969
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Provider Business Mailing Address
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Address Line | 14016 BORA BORA WAY #238
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6889
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Country | US
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Telephone | 213-488-9559
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 23023
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 56437
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License Number State | CA
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