NORMA LYNN BLACKWATER M.D. NPI 1457476038

NPI Information

NPI: 1457476038
Provider Name: NORMA LYNN BLACKWATER, M.D.
Classification: General Practice - 208D00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
1125 W 6TH ST
SUITE 103
LOS ANGELES, CA
ZIP 90017
Phone: (213) 202-3970
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Norma Lynn Blackwater, M.D. is a general practice in Los Angeles, CA with 31 years of experience. Norma Lynn Blackwater, M.D. NPI is 1457476038. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINE
Graduation Year:1993

The provider's business location address is:

1125 W 6TH ST
SUITE 103
LOS ANGELES, CA
ZIP 90017-833
Phone: (213) 202-3970
Fax: (213) 975-9257

The NPI 1457476038 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/20/2007 and was last updated on 12/8/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice		G83912	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00G839120	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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