Provider Demographics
NPI:1851459192
Name:BLAND, JEANETTE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:ELIZABETH
Last Name:BLAND
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 1:851 FREMONT AVE
Mailing Address - Street 2:#98
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024
Mailing Address - Country:US
Mailing Address - Phone:650-494-9360
Mailing Address - Fax:650-559-5926
Practice Address - Street 1:851 FREMONT AVE
Practice Address - Street 2:SUITE 98
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024
Practice Address - Country:US
Practice Address - Phone:650-494-9360
Practice Address - Fax:650-559-5926
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG650062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF21648Medicare UPIN
CA00G650062Medicare ID - Type Unspecified