Provider Demographics
NPI:1356589634
Name:CARLOS BLANCHE MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:CARLOS BLANCHE MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-296-9669
Mailing Address - Street 1:1310 W. STEWART DRIVE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3856
Mailing Address - Country:US
Mailing Address - Phone:714-997-2224
Mailing Address - Fax:714-997-1187
Practice Address - Street 1:1310 W. STEWART DRIVE
Practice Address - Street 2:SUITE 503
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3856
Practice Address - Country:US
Practice Address - Phone:714-997-2224
Practice Address - Fax:714-997-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty