Provider Demographics
NPI:1346561529
Name:CARL I BLAU M D INC
Entity Type:Organization
Organization Name:CARL I BLAU M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:I
Authorized Official - Last Name:BLAU
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:818-886-6848
Mailing Address - Street 1:PO BOX 260710
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-0710
Mailing Address - Country:US
Mailing Address - Phone:818-886-6848
Mailing Address - Fax:818-886-0352
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:#228
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1502
Practice Address - Country:US
Practice Address - Phone:818-886-6848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23803174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A238030Medicaid
CA00A238030Medicaid