Provider Demographics
NPI:1326322306
Name:EICHNER BLANUSA, LORA K (MD)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:K
Last Name:EICHNER BLANUSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TRANCAS STREET
Mailing Address - Street 2:SUITE 270
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558
Mailing Address - Country:US
Mailing Address - Phone:707-252-1076
Mailing Address - Fax:707-252-4764
Practice Address - Street 1:1100 TRANCAS STREET
Practice Address - Street 2:SUITE 270
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558
Practice Address - Country:US
Practice Address - Phone:707-252-1076
Practice Address - Fax:707-252-4764
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80320208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics