Provider Demographics
NPI:1306025556
Name:BLOUNT, ANDREW JEREMIAH
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JEREMIAH
Last Name:BLOUNT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 LOMA ALTA AVE
Mailing Address - Street 2:EASTFIELD MING QUONG
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-4923
Mailing Address - Country:US
Mailing Address - Phone:408-835-5689
Mailing Address - Fax:
Practice Address - Street 1:499 LOMA ALTA AVENUE
Practice Address - Street 2:EASTFIELD MING QUONG INC
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-4923
Practice Address - Country:US
Practice Address - Phone:408-835-5689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator