MEDICARE: DR. DUMONT GARY BLANKENSHIP PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY8627	CA

General Provider Information

NPI Number	:	1063506806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUMONT GARY BLANKENSHIP PH.D

Provider Business Mailing Address
First Line	:	3210 GARRISON ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-2110
Country	:	US
Telephone Number	:	619-224-3001
Fax Number	:

Provider Business Practice Location Address
First Line	:	3142 VISTA WAY
Second Line	:	205
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-3619
Country	:	US
Telephone Number	:	760-758-1480
Fax Number	:	760-435-9472

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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