Provider Demographics
NPI:1639175409
Name:BLUMENSTRAUCH, ROY B (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:B
Last Name:BLUMENSTRAUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 TORRANCE BLVD
Mailing Address - Street 2:STE 640
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4504
Mailing Address - Country:US
Mailing Address - Phone:310-543-4444
Mailing Address - Fax:310-543-4446
Practice Address - Street 1:4201 TORRANCE BLVD
Practice Address - Street 2:STE 640
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4504
Practice Address - Country:US
Practice Address - Phone:310-543-4444
Practice Address - Fax:310-543-4446
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-11-27
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CAG54548174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG54548GMedicare UPIN