MEDICARE: DR. BETALINA BLANCO BUMATAY M.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	208000000X	Pediatrics Physician	A50060	CA

General Provider Information

NPI Number	:	1477510097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETALINA BLANCO BUMATAY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 255228
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95865-5228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 SAINT DOMINICS DR STE 201
Second Line	:
City	:	MANTECA
State	:	CA
Zip	:	95337-7802
Country	:	US
Telephone Number	:	209-823-2345
Fax Number	:

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	02/20/2024

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