Provider Demographics
NPI:1518026848
Name:LAURIE BLANSCET, DO AN OSTEOPATHIC CORPORATION
Entity Type:Organization
Organization Name:LAURIE BLANSCET, DO AN OSTEOPATHIC CORPORATION
Other - Org Name:SUMMIT FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANSCET
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-461-3021
Mailing Address - Street 1:29995 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2632
Mailing Address - Country:US
Mailing Address - Phone:951-461-3021
Mailing Address - Fax:951-461-3021
Practice Address - Street 1:29995 TECHNOLOGY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2632
Practice Address - Country:US
Practice Address - Phone:951-461-3021
Practice Address - Fax:951-461-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10942752OtherCAQH
CADG7185OtherMEDICARE RAILROAD GROUP NO.
CAZZZ32187ZMedicare PIN