Provider Demographics
NPI:1255630372
Name:MARSHA J. BLUTO, M.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MARSHA J. BLUTO, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLUTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-380-1840
Mailing Address - Street 1:PO BOX 2490
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94942-2490
Mailing Address - Country:US
Mailing Address - Phone:415-380-1840
Mailing Address - Fax:415-380-1842
Practice Address - Street 1:591 REDWOOD HIGHWAY
Practice Address - Street 2:SUITE 5285
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3064
Practice Address - Country:US
Practice Address - Phone:415-380-1840
Practice Address - Fax:415-380-1842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106091261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty