Provider Demographics
NPI:1275744252
Name:BLANTZ, MERRY CHRISTINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:MERRY
Middle Name:CHRISTINE
Last Name:BLANTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:MERRY
Other - Middle Name:CHRISTINE
Other - Last Name:BIBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:200 WEST ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8409
Mailing Address - Country:US
Mailing Address - Phone:619-543-5656
Mailing Address - Fax:619-543-3511
Practice Address - Street 1:200 WEST ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8409
Practice Address - Country:US
Practice Address - Phone:619-543-5656
Practice Address - Fax:619-543-3511
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231084363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAT920ZMedicare PIN