Provider Demographics
NPI:1861648164
Name:ANTHONY BLEDIN MD INC
Entity Type:Organization
Organization Name:ANTHONY BLEDIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BLEDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-494-9940
Mailing Address - Street 1:1851 HOLSER WALK STE 220
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2626
Mailing Address - Country:US
Mailing Address - Phone:805-988-1111
Mailing Address - Fax:805-988-0254
Practice Address - Street 1:7301 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-2254
Practice Address - Country:US
Practice Address - Phone:323-778-2131
Practice Address - Fax:323-778-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42124291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C421240Medicaid
CAW10935Medicare PIN