Provider Demographics
NPI:1679653927
Name:FERNANDEZ-KLINE, BLANCA ESTELA (MD)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:ESTELA
Last Name:FERNANDEZ-KLINE
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 1:319 N MILPAS ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-3262
Mailing Address - Country:US
Mailing Address - Phone:805-965-3011
Mailing Address - Fax:805-965-3441
Practice Address - Street 1:319 N MILPAS ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-3262
Practice Address - Country:US
Practice Address - Phone:805-965-3011
Practice Address - Fax:805-965-3441
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7723207Q00000X
CAA106885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169050501Medicaid
CAW14270AMedicare PIN
I03141Medicare UPIN
TX169050501Medicaid
CAW14270Medicare PIN