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General NPI Number Information
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NPI Number | 1982961702
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Entity Type | Individual
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Provider Name | NELLIE ANN BLUNT PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 6250 EL CAMINO REAL
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City | CARLSBAD
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State | CA
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Zip | 92009-1603
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Country | US
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Telephone | 760-603-8801
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Fax | 760-931-3126
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Provider Business Mailing Address
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Address Line | 27067 SUNNINGDALE WAY
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City | VALLEY CENTER
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State | CA
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Zip | 92082-6642
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Country | US
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Telephone | 760-525-4475
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Fax | 760-751-4215
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA17354
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License Number State | CA
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