Provider Demographics
NPI:1912967324
Name:BLITZER, JONATHAN B (MD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:B
Last Name:BLITZER
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 1:2810 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1558
Mailing Address - Country:US
Mailing Address - Phone:562-933-1877
Mailing Address - Fax:
Practice Address - Street 1:2810 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1558
Practice Address - Country:US
Practice Address - Phone:562-933-1877
Practice Address - Fax:562-933-1886
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG062021174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0029650Medicaid
CAA53672Medicare UPIN