Provider Demographics
NPI:1417058140
Name:BLUMSTEIN, NANCY LEE (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LEE
Last Name:BLUMSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:LEE
Other - Last Name:EDELSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9696 CULVER BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232
Mailing Address - Country:US
Mailing Address - Phone:310-204-6897
Mailing Address - Fax:310-204-4690
Practice Address - Street 1:9696 CULVER BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232
Practice Address - Country:US
Practice Address - Phone:310-204-6897
Practice Address - Fax:310-204-4690
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA043068208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics