Provider Demographics
NPI:1578804084
Name:BLATT, ELEANOR S (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:S
Last Name:BLATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-3914
Mailing Address - Country:US
Mailing Address - Phone:714-536-1624
Mailing Address - Fax:
Practice Address - Street 1:212 20TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-3914
Practice Address - Country:US
Practice Address - Phone:714-536-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71292080A0000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice