Provider Demographics
NPI:1013539717
Name:BLANC, SUSAN ASTRID (NC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ASTRID
Last Name:BLANC
Suffix:
Gender:F
Credentials:NC
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Mailing Address - Street 1:2303 CAMINO RAMON # 208
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1392
Mailing Address - Country:US
Mailing Address - Phone:510-610-4644
Mailing Address - Fax:925-407-8344
Practice Address - Street 1:2303 CAMINO RAMON # 208
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1392
Practice Address - Country:US
Practice Address - Phone:510-610-4644
Practice Address - Fax:925-407-8344
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education