Provider Demographics
NPI:1407259740
Name:BLUM, SYLVIA N/A (PPS CREDENTIAL)
Entity Type:Individual
Prefix:MISS
First Name:SYLVIA
Middle Name:N/A
Last Name:BLUM
Suffix:
Gender:F
Credentials:PPS CREDENTIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 VIA PACIFICA
Mailing Address - Street 2:APT. J103
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-6707
Mailing Address - Country:US
Mailing Address - Phone:562-230-9487
Mailing Address - Fax:
Practice Address - Street 1:1690 VIA PACIFICA
Practice Address - Street 2:APT. J103
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-6707
Practice Address - Country:US
Practice Address - Phone:562-230-9487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140077321103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool