Provider Demographics
NPI:1790847424
Name:BLUM, MARIAN (LAC)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:BLUM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:25325 TIERRA GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8413
Mailing Address - Country:US
Mailing Address - Phone:831-625-5827
Mailing Address - Fax:831-625-5827
Practice Address - Street 1:801 LIGHTHOUSE AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1046
Practice Address - Country:US
Practice Address - Phone:831-373-6600
Practice Address - Fax:831-373-6600
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC6674171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist