Provider Demographics
NPI:1497705099
Name:BLESA, ENRIQUE SERGIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:SERGIO
Last Name:BLESA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SERGIO
Other - Middle Name:
Other - Last Name:BLESA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3452 E FOOTHILL BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-6006
Mailing Address - Country:US
Mailing Address - Phone:626-793-2885
Mailing Address - Fax:626-793-6262
Practice Address - Street 1:289 W HUNTINGTON DR
Practice Address - Street 2:SUITE 401
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3495
Practice Address - Country:US
Practice Address - Phone:626-254-0074
Practice Address - Fax:626-254-0079
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31529207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A315290Medicaid
CAWA31529JOtherMEDICARE PTAN
CAWA31529JOtherMEDICARE PTAN
CAA26518Medicare UPIN
CA00A315290Medicaid