MEDICARE: JOHN BLASCO L.C.S.W.

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	1041C0700X	Clinical Social Worker	LCS16994	CA

General Provider Information

NPI Number	:	1275874943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BLASCO L.C.S.W.

Provider Business Mailing Address
First Line	:	1045 ATLANTIC AVE STE 1016
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3410
Country	:	US
Telephone Number	:	562-624-4915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 ATLANTIC AVE STE 1016
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3410
Country	:	US
Telephone Number	:	562-624-4915
Fax Number	:

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

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	05/09/2016

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