Provider Demographics
NPI:1669772331
Name:BLUETT, BRENT ROBERT (DO)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:ROBERT
Last Name:BLUETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 E MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 FAIR OAKS AVE STE 220
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3929
Practice Address - Country:US
Practice Address - Phone:805-547-2224
Practice Address - Fax:805-473-5931
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2025-05-16
Deactivation Date:2025-04-27
Deactivation Code:
Reactivation Date:2025-05-16
Provider Licenses
StateLicense IDTaxonomies
CA134232084N0400X
CA20A134232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology