Provider Demographics
NPI:1356679237
Name:BLAND, CODY A
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:A
Last Name:BLAND
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 1:910 S PACIFIC ST
Mailing Address - Street 2:#2
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3960
Mailing Address - Country:US
Mailing Address - Phone:760-754-9297
Mailing Address - Fax:
Practice Address - Street 1:7020 FRIARS RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1126
Practice Address - Country:US
Practice Address - Phone:619-718-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN213520164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse