Provider Demographics
NPI:1922092410
Name:SHANBLATT, NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:
Last Name:SHANBLATT
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 1:1304 15TH ST STE 402
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1813
Mailing Address - Country:US
Mailing Address - Phone:310-451-0111
Mailing Address - Fax:310-451-0202
Practice Address - Street 1:1304 15TH ST STE 402
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1813
Practice Address - Country:US
Practice Address - Phone:310-451-0111
Practice Address - Fax:310-451-0202
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A646470Medicaid
CA00A646470Medicaid
CAWA64647CMedicare ID - Type Unspecified